Provider Demographics
NPI:1396012852
Name:SERVICORP RESOURCE CENTER, INC.
Entity Type:Organization
Organization Name:SERVICORP RESOURCE CENTER, INC.
Other - Org Name:SERVICORP COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:PRICE
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:706-755-2095
Mailing Address - Street 1:1904 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5305
Mailing Address - Country:US
Mailing Address - Phone:706-755-2095
Mailing Address - Fax:706-755-2095
Practice Address - Street 1:1904 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904
Practice Address - Country:US
Practice Address - Phone:706-755-2095
Practice Address - Fax:706-755-2095
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERVICORP RESOURCE CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020772253103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty