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3120 N Oak Street Ext Ste B Valdosta GA 31602-5910 | |
| (229) 671-6164 | |
| (229) 671-6750 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 3120 N Oak Street Ext Ste B, Valdosta, Georgia |
| Authorized Official Name and Position | William F. Huling (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2296716140 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3120 N Oak Street Ext Ste C Valdosta GA 31602-5910 Ph: (229) 671-6100 | 3120 N Oak Street Ext Ste B Valdosta GA 31602-5910 Ph: (229) 671-6164 |
| NPI Number | 1144394941 |
|---|---|
| Provider Enumeration Date | 11/20/2006 |
| Last Update Date | 03/31/2020 |
| Certification Date | 03/31/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144394941 | NPI | - | NPPES |
| 000742475M | Medicaid | GA |
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