Provider Demographics
NPI:1992585483
Name:ARC HOUSE OF ELAVATION INC OF THOMASVILLE
Entity type:Organization
Organization Name:ARC HOUSE OF ELAVATION INC OF THOMASVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARDRIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:229-403-7047
Mailing Address - Street 1:305 HAYDEN WAY
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-0316
Mailing Address - Country:US
Mailing Address - Phone:229-403-7047
Mailing Address - Fax:
Practice Address - Street 1:127 SMITH AVE STE F
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5593
Practice Address - Country:US
Practice Address - Phone:229-236-1449
Practice Address - Fax:229-236-1869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty