Organization
CLASSROOM21
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH WAYNE O'BARA LMSW (CO-FOUNDER)
(912) 281-2251
Entity
Organization
Contact information
Practice address
527 RAILROAD ST, FORT VALLEY, GA 31030-2700
(478) 396-5489
Mailing address
527 RAILROAD ST, FORT VALLEY, GA 31030-2700
(478) 396-5489
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/23/2023
Last updated
01/23/2023
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