Provider Demographics
NPI:1912373051
Name:LAYNE CENTER FOR THERAPY, EDUCATION, AND ASSESSMENT
Entity Type:Organization
Organization Name:LAYNE CENTER FOR THERAPY, EDUCATION, AND ASSESSMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-922-1245
Mailing Address - Street 1:805 S. GLYNN ST
Mailing Address - Street 2:STE 127 #322
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2000
Mailing Address - Country:US
Mailing Address - Phone:404-922-1245
Mailing Address - Fax:
Practice Address - Street 1:805 S. GLYNN ST
Practice Address - Street 2:STE 127 #322
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2000
Practice Address - Country:US
Practice Address - Phone:404-922-1245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty