Organization
LOOKOUT MOUNTAIN COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS W. FORD PH.D. (EXECUTIVE DIRECTOR)
(706) 638-5584
Entity
Organization
Contact information
Practice address
501 MIZE STREET, LA FAYETTE, GA 30728
(706) 638-5584
(706) 638-5585
Mailing address
PO BOX 1027, LA FAYETTE, GA 30728-1027
(706) 638-5584
(706) 638-5585
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55002216A-21
—
GA
Enumeration date
11/15/2006
Last updated
08/15/2007
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