| Purpose Place, Llc | |
|
1121 Laney Walker Blvd Augusta GA 30901-2869 | |
| (706) 267-9647 | |
| Not Available |
| Full Name | Purpose Place, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1121 Laney Walker Blvd, Augusta, Georgia |
| Authorized Official Name and Position | Tasha Wilder (CEO) |
| Authorized Official Contact | 7062679647 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Purpose Place, Llc Po Box 5052 Augusta GA 30916-5052 Ph: () - | Purpose Place, Llc 1121 Laney Walker Blvd Augusta GA 30901-2869 Ph: (706) 267-9647 |
| NPI Number | 1801415476 |
|---|---|
| Provider Enumeration Date | 04/13/2020 |
| Last Update Date | 04/13/2020 |
| Certification Date | 04/13/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801415476 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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