Provider Demographics
NPI:1902366297
Name:COMPREHENSIVE AUTISM AND PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE AUTISM AND PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TWYLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANCIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:229-977-6806
Mailing Address - Street 1:554 HALL RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-8105
Mailing Address - Country:US
Mailing Address - Phone:229-977-6806
Mailing Address - Fax:
Practice Address - Street 1:554 HALL RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-8105
Practice Address - Country:US
Practice Address - Phone:229-977-6806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty