Organization
WIDE RANGE OF RESOURCES,IINC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. FREZALIA L. OLIVER LCSW (CLINICAL DIRECTOR)
(478) 451-3112
Entity
Organization
Contact information
Practice address
1776 N JEFFERSON ST NE STE B, MILLEDGEVILLE, GA 31061-2292
(478) 451-3112
(478) 451-0626
Mailing address
1776 N JEFFERSON ST NE STE B, MILLEDGEVILLE, GA 31061-2292
(478) 451-3112
(478) 451-0626
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
CSW000658
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139858482A
—
GA
05
—
139858482B
—
GA
01
—
GRP7368
GROUP PIN
GA
Enumeration date
10/05/2007
Last updated
10/05/2007
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