Organization
INFORMED GROUP ENTERPRISES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LYLE COALWELL LPC (COUNSELOR)
(770) 298-5094
Entity
Organization
Contact information
Practice address
4737 S SEMINOLE DR, DOUGLASVILLE, GA 30135-4641
(770) 298-5094
Mailing address
4737 S SEMINOLE DR, DOUGLASVILLE, GA 30135-4641
(770) 298-5094
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC002580
GA
174400000X
Specialist
—
—
Other
Enumeration date
08/02/2012
Last updated
08/02/2012
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