| Molding Passionate Active Creative Kids Corporation | |
|
302 N Park St Carrollton GA 30117-3056 | |
| (678) 849-4656 | |
| Not Available |
| Full Name | Molding Passionate Active Creative Kids Corporation |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 302 N Park St, Carrollton, Georgia |
| Authorized Official Name and Position | Demarcus Devon Copelannd (FOUNDER AND PROGRAM DIRECTOR) |
| Authorized Official Contact | 6788494656 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Molding Passionate Active Creative Kids Corporation 302 N Park St Carrollton GA 30117-3056 Ph: (678) 849-4656 | Molding Passionate Active Creative Kids Corporation 302 N Park St Carrollton GA 30117-3056 Ph: (678) 849-4656 |
| NPI Number | 1417700972 |
|---|---|
| Provider Enumeration Date | 04/05/2024 |
| Last Update Date | 04/05/2024 |
| Certification Date | 04/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417700972 | NPI | - | NPPES |
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