Organization
GEORGE JUNIOR REPUBLIC IN INDIANA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISA R COX LCSW (CLINICAL SUPERVISOR)
(812) 722-3137
Entity
Organization
Contact information
Practice address
3925 S. GARTHWAITE RD, GAS CITY, IN 46933
(812) 722-3137
(812) 372-9299
Mailing address
3925 S. GARTHWAITE RD, GAS CITY, IN 46933
(812) 722-3137
(812) 372-9299
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
104100000X
Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
253J00000X
Foster Care Agency
Primary
152783933
IN
253J00000X
Foster Care Agency
54490098
IN
Other
Enumeration date
10/05/2011
Last updated
04/10/2019
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