Provider Demographics
NPI:1427594068
Name:NEW BEGINNINGS COMMUNITY OUTREACH PROGRAM INC
Entity type:Organization
Organization Name:NEW BEGINNINGS COMMUNITY OUTREACH PROGRAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS, LPC, CCTP, CRC
Authorized Official - Phone:229-246-9050
Mailing Address - Street 1:617 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-3915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:617 S WEST ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-3915
Practice Address - Country:US
Practice Address - Phone:229-246-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW BEGINNINGS COMMUNITY OUTREACH PROGRAM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5946251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1417275512OtherNPI