Provider Demographics
NPI:1730503632
Name:CENTER FOR PERSONAL AND FAMILY GROWTH LLC
Entity type:Organization
Organization Name:CENTER FOR PERSONAL AND FAMILY GROWTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:TREXLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:229-588-1034
Mailing Address - Street 1:2704 N OAK ST BLDG L
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1790
Mailing Address - Country:US
Mailing Address - Phone:229-671-1461
Mailing Address - Fax:229-671-1471
Practice Address - Street 1:2704 N OAK ST BLDG L
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1790
Practice Address - Country:US
Practice Address - Phone:229-671-1461
Practice Address - Fax:229-671-1471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty