Organization · NPI-2

Loganville Community Ministry Village, INC.

Community/Behavioral Health · Loganville, GA

NPI number1124253679
StatusActive
Last updated in NPPESMay 27, 2009

Details

NPI
1124253679
Entity type
Organization (NPI-2)
Legal business name
Loganville Community Ministry Village, INC.
Organization subpart
No
Enumeration date
May 27, 2009
Last updated
May 27, 2009

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
251S00000X Community/Behavioral HealthLPC005585GAYes

Practice location

678 Tom Brewer Rd
Loganville, GA 30052-4005

Phone 770-554-3599 · Fax 770-554-3514

Mailing address

678 Tom Brewer Rd
Loganville, GA 30052-4005

Phone 770-554-3599 · Fax 770-554-3514

Authorized official

Chet Allen Fowler
Executive Director
7705543599

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