Organization
LOGANVILLE COMMUNITY MINISTRY VILLAGE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHET ALLEN FOWLER LPC (EXECUTIVE DIRECTOR)
(770) 554-3599
Entity
Organization
Contact information
Practice address
678 TOM BREWER RD, LOGANVILLE, GA 30052-4005
(770) 554-3599
(770) 554-3514
Mailing address
678 TOM BREWER RD, LOGANVILLE, GA 30052-4005
(770) 554-3599
(770) 554-3514
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LPC005585
GA
Other
Enumeration date
05/27/2009
Last updated
05/27/2009
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