Provider Demographics
NPI:1780738690
Name:MARY LOU FRASER FOUNDATION FOR FAMILIES, INC.
Entity type:Organization
Organization Name:MARY LOU FRASER FOUNDATION FOR FAMILIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:I
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-369-7777
Mailing Address - Street 1:203 MARY LOU DRIVE
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313
Mailing Address - Country:US
Mailing Address - Phone:912-369-7777
Mailing Address - Fax:912-369-2030
Practice Address - Street 1:203 MARY LOU DR
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3413
Practice Address - Country:US
Practice Address - Phone:912-369-7777
Practice Address - Fax:912-369-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty