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Organization

BAGLEY YOUTH DEVELOPMENT

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. GEORGIANA BAGLEY M.S., LPC (CEO)
(404) 968-4662
Entity
Organization

Contact information

Practice address
2245 GODBY RD, SUITE 206, COLLEGE PARK, GA 30349-5059
(404) 968-4662
(404) 968-4562
Mailing address
375 WINDERMERE CIR, NEWNAN, GA 30265-2278
(678) 362-7802
(404) 968-4562

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LPC001132
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
503205308A
GA
Enumeration date
01/31/2007
Last updated
05/19/2009
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