Provider Demographics
NPI:1114116829
Name:WEST GEORGIA COUNSELING & ASSESSMENT SERVICES
Entity type:Organization
Organization Name:WEST GEORGIA COUNSELING & ASSESSMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:FARRAR
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:706-837-0045
Mailing Address - Street 1:PO BOX 4078
Mailing Address - Street 2:98 GORDON COMMERCIAL DRIVE
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-0082
Mailing Address - Country:US
Mailing Address - Phone:706-837-0045
Mailing Address - Fax:706-837-0035
Practice Address - Street 1:98 GORDON COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-5735
Practice Address - Country:US
Practice Address - Phone:706-837-0045
Practice Address - Fax:706-837-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health