Provider Demographics
NPI:1609908581
Name:TWI COUNSELING
Entity Type:Organization
Organization Name:TWI COUNSELING
Other - Org Name:TONY WARDLAW INCORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THADEUS
Authorized Official - Middle Name:MANDRALL
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, MS
Authorized Official - Phone:912-423-9179
Mailing Address - Street 1:P.O. BOX 178
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-0178
Mailing Address - Country:US
Mailing Address - Phone:912-537-9280
Mailing Address - Fax:912-537-9440
Practice Address - Street 1:506 DONOVAN STREET
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-0178
Practice Address - Country:US
Practice Address - Phone:912-537-9280
Practice Address - Fax:912-537-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
GALPC004269251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management