Provider Demographics
NPI:1962972075
Name:MOVING SPIRIT FOUNDATION INC.
Entity type:Organization
Organization Name:MOVING SPIRIT FOUNDATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCRARY
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:706-938-8008
Mailing Address - Street 1:116 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-2227
Mailing Address - Country:US
Mailing Address - Phone:706-938-8008
Mailing Address - Fax:
Practice Address - Street 1:113B E COUNTY RD
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-2233
Practice Address - Country:US
Practice Address - Phone:706-938-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health