Provider Demographics
NPI:1700249810
Name:FAUBION THERAPY CENTER INC
Entity Type:Organization
Organization Name:FAUBION THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALZIRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUBION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-925-3306
Mailing Address - Street 1:105 GOVERNORS SQ
Mailing Address - Street 2:SUITE E
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4866
Mailing Address - Country:US
Mailing Address - Phone:678-925-3306
Mailing Address - Fax:678-985-4855
Practice Address - Street 1:105 GOVERNORS SQ
Practice Address - Street 2:SUITE E
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4866
Practice Address - Country:US
Practice Address - Phone:678-925-3306
Practice Address - Fax:678-985-4855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006470101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty