Provider Demographics
NPI:1396924320
Name:MIDDLE TYGER COMMUNITY CENTER
Entity type:Organization
Organization Name:MIDDLE TYGER COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC LMFT
Authorized Official - Phone:864-439-7760
Mailing Address - Street 1:84 GROCE RD
Mailing Address - Street 2:MIDDLE TYGER COMMUNITY CENTER
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365
Mailing Address - Country:US
Mailing Address - Phone:864-439-7760
Mailing Address - Fax:864-439-7034
Practice Address - Street 1:84 GROCE RD
Practice Address - Street 2:MIDDLE TYGER COMMUNITY CENTER
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365
Practice Address - Country:US
Practice Address - Phone:864-439-7760
Practice Address - Fax:864-439-7034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2745106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty