Organization
LOOKOUT MOUNTAIN COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA MYERS LPC (CLINICAN)
(706) 861-3387
Entity
Organization
Contact information
Practice address
1875 FANT DR, FORT OGLETHORPE, GA 30742-3307
(706) 861-3387
Mailing address
1875 FANT DR, FORT OGLETHORPE, GA 30742-3307
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
86290
TN
310500000X
Mental Illness Intermediate Care Facility
Primary
LPN090474
GA
Other
Enumeration date
07/30/2015
Last updated
07/30/2015
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