Provider Demographics
NPI:1407463177
Name:GIVE KINDNESS WING
Entity Type:Organization
Organization Name:GIVE KINDNESS WING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:KAYLA
Authorized Official - Last Name:PURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:229-985-0090
Mailing Address - Street 1:PO BOX 3795
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-3795
Mailing Address - Country:US
Mailing Address - Phone:229-985-0090
Mailing Address - Fax:
Practice Address - Street 1:18 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-4573
Practice Address - Country:US
Practice Address - Phone:229-985-0090
Practice Address - Fax:229-396-4605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health