Provider Demographics
NPI:1912061110
Name:GEORGIA INTERVENTION PROGRAMS AND SERVICES
Entity Type:Organization
Organization Name:GEORGIA INTERVENTION PROGRAMS AND SERVICES
Other - Org Name:GIPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLACKS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:229-424-7000
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-0073
Mailing Address - Country:US
Mailing Address - Phone:229-424-7000
Mailing Address - Fax:229-424-7074
Practice Address - Street 1:201 E OHOOPEE ST
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-1727
Practice Address - Country:US
Practice Address - Phone:229-424-7000
Practice Address - Fax:229-424-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty