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501 Mize St La Fayette GA 30728-3346 | |
| (706) 638-5580 | |
| (706) 638-5445 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 501 Mize St, La Fayette, Georgia |
| Authorized Official Name and Position | Alicia Michelle Howard (CREDENTIALING) |
| Authorized Official Contact | 7066701080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1027 La Fayette GA 30728-1027 Ph: (706) 638-5580 | 501 Mize St La Fayette GA 30728-3346 Ph: (706) 638-5580 |
| NPI Number | 1194047225 |
|---|---|
| Provider Enumeration Date | 02/16/2010 |
| Last Update Date | 02/10/2023 |
| Certification Date | 02/10/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194047225 | NPI | - | NPPES |
| 000604513DN | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Lookout Mountain Community Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 214 Jones Rd, La Fayette, GA 30728 Phone: 706-638-5580 Fax: 706-638-5445 | |
Lookout Mountain Community Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2448 Corinth Rd, La Fayette, GA 30728 Phone: 706-638-5580 Fax: 706-638-5585 | |
Lookout Mountain Community Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 Mize St, La Fayette, GA 30728 Phone: 706-638-5580 | |
Northwest Georgia Psychological Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 406 N Main St, La Fayette, GA 30728 Phone: 706-638-2339 Fax: 706-638-7400 |