Loganville Community Ministry Village, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LPC005585 Issued in GA

Legal business name

LOGANVILLE COMMUNITY MINISTRY VILLAGE, INC.

Practice address

678 Tom Brewer Rd
Loganville, GA 30052-4005

Phone

(770) 554-3599

Fax

(770) 554-3514

NPI assigned

May 27, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Chet Allen Fowler, LPC

Title

Executive Director

Phone

(770) 554-3599

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1243382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243382400000",
    "number": "1124253679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "678 TOM BREWER RD",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300524005",
            "telephone_number": "770-554-3599",
            "fax_number": "770-554-3514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "678 TOM BREWER RD",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300524005",
            "telephone_number": "770-554-3599",
            "fax_number": "770-554-3514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGANVILLE COMMUNITY MINISTRY VILLAGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-27",
        "last_updated": "2009-05-27",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "CHET",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "770-554-3599",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "LPC005585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.