Organization
INTROSPECTION & REFLECTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAYSHA PHIMPHONE LPC (OWNER)
(912) 346-5344
Entity
Organization
Contact information
Practice address
184 HAMILTON GROVE DR, POOLER, GA 31322-9644
(912) 346-5344
Mailing address
184 HAMILTON GROVE DRIVE, POOLER, GA 31322
(912) 346-5344
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
009203
GA
Other
Enumeration date
02/02/2017
Last updated
02/02/2017
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