Provider Demographics
NPI:1386266088
Name:FAMILY TREE COUNSELING AND TRAINING CENTER LLC
Entity type:Organization
Organization Name:FAMILY TREE COUNSELING AND TRAINING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-304-4878
Mailing Address - Street 1:187 ROBERSON MILL RD NE STE 110
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-4925
Mailing Address - Country:US
Mailing Address - Phone:478-304-4878
Mailing Address - Fax:
Practice Address - Street 1:187 ROBERSON MILL RD NE STE 110
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-4925
Practice Address - Country:US
Practice Address - Phone:478-304-4878
Practice Address - Fax:478-215-0361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)