Provider Demographics
NPI:1962976696
Name:FIRST BAPTIST CHURCH OF WOODSTOCK, INC
Entity type:Organization
Organization Name:FIRST BAPTIST CHURCH OF WOODSTOCK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COUNSELING
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:EUBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LPC
Authorized Official - Phone:770-591-4770
Mailing Address - Street 1:3380 TRICKUM RD BLDG 700 SUITE 100
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3680
Mailing Address - Country:US
Mailing Address - Phone:770-591-4770
Mailing Address - Fax:770-592-3120
Practice Address - Street 1:3380 TRICKUM RD
Practice Address - Street 2:BLDG 700, SUITE 100
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188
Practice Address - Country:US
Practice Address - Phone:770-591-4770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health