Organization
WYLLOWSWAY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERA LYNN IRVINE LPC,CEAP, (THERAPIST)
(478) 361-2875
Entity
Organization
Contact information
Practice address
105 WILLIAM WAY, MACON, GA 31216-6160
(478) 327-7683
(478) 781-1395
Mailing address
105 WILLIAM WAY, MACON, GA 31216-6160
(478) 327-7683
(478) 781-1395
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LPC3186
GA
Other
Enumeration date
06/10/2016
Last updated
06/20/2016
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