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Organization
THE PEACH PIT
Active
Organization
THE PEACH PIT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GWENDOLYN COLEY LCSW (CLINICAL DIRECTOR)
(478) 827-3224
Entity
Organization
Contact information
Practice address
1809 RIVER RD, FORT VALLEY, GA 31030-7029
(478) 827-3224
Mailing address
PO BOX 891, FORT VALLEY, GA 31030-0891
(478) 827-3224
(478) 827-3224
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
174400000X
Specialist
—
—
251V00000X
Voluntary or Charitable Agency
—
—
Other
Enumeration date
03/08/2018
Last updated
03/29/2021
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