Provider Demographics
NPI:1225576796
Name:ECLECTICS
Entity Type:Organization
Organization Name:ECLECTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFONZA
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:706-566-3169
Mailing Address - Street 1:3846 TRASK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31903-2937
Mailing Address - Country:US
Mailing Address - Phone:706-566-3169
Mailing Address - Fax:
Practice Address - Street 1:3846 TRASK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31903-2937
Practice Address - Country:US
Practice Address - Phone:706-566-3169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009399251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health