Provider Demographics
NPI:1639425150
Name:INFORMED GROUP ENTERPRISES
Entity Type:Organization
Organization Name:INFORMED GROUP ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COALWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-298-5094
Mailing Address - Street 1:4737 S SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-4641
Mailing Address - Country:US
Mailing Address - Phone:770-298-5094
Mailing Address - Fax:
Practice Address - Street 1:4737 S SEMINOLE DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-4641
Practice Address - Country:US
Practice Address - Phone:770-298-5094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002580101Y00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty