Provider Demographics
NPI:1225292428
Name:JIM LANIER, ACSW (DBA) CENTER FOR FAMILY GROWTH
Entity Type:Organization
Organization Name:JIM LANIER, ACSW (DBA) CENTER FOR FAMILY GROWTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:912-264-2369
Mailing Address - Street 1:PO BOX 1932
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31521-1932
Mailing Address - Country:US
Mailing Address - Phone:912-264-2369
Mailing Address - Fax:912-264-2365
Practice Address - Street 1:502 GLOUCESTER ST
Practice Address - Street 2:SUITE 8
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-7013
Practice Address - Country:US
Practice Address - Phone:912-264-2369
Practice Address - Fax:912-264-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBBCZMedicare PIN
GAR74750Medicare UPIN