Provider Demographics
NPI:1770686024
Name:INGE LUECHINGER FAMILY THERAPY PC
Entity Type:Organization
Organization Name:INGE LUECHINGER FAMILY THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:INGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUECHINGER
Authorized Official - Suffix:
Authorized Official - Credentials:APRNPMH
Authorized Official - Phone:678-438-4233
Mailing Address - Street 1:1269 PARKER RD SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5957
Mailing Address - Country:US
Mailing Address - Phone:678-438-4233
Mailing Address - Fax:770-761-9070
Practice Address - Street 1:1269 PARKER RD SE STE 3D
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5957
Practice Address - Country:US
Practice Address - Phone:678-438-4233
Practice Address - Fax:770-761-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN079843 CNS/PMH363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA609588713AMedicaid
GA609588713Medicaid