Provider Demographics
NPI:1760157200
Name:FOUNDATIONAL LINK THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:FOUNDATIONAL LINK THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, MAC
Authorized Official - Phone:678-416-1584
Mailing Address - Street 1:46 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-2034
Mailing Address - Country:US
Mailing Address - Phone:678-416-1584
Mailing Address - Fax:
Practice Address - Street 1:5 1/2 W WASHINGTON ST STE 6
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-2026
Practice Address - Country:US
Practice Address - Phone:678-416-1584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health