Provider Demographics
NPI:1376158360
Name:TWO RIVERS COUNSELING AND PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:TWO RIVERS COUNSELING AND PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LORMIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:912-980-5074
Mailing Address - Street 1:72 BONNIE REED PSGE
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:GA
Mailing Address - Zip Code:31320-4925
Mailing Address - Country:US
Mailing Address - Phone:912-421-4432
Mailing Address - Fax:912-525-2897
Practice Address - Street 1:72 BONNIE REED PSGE
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320-4925
Practice Address - Country:US
Practice Address - Phone:912-421-4432
Practice Address - Fax:912-525-2897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty