Provider Demographics
NPI:1952636045
Name:THE PROGRESSIVE INTERVENTION NETWORK INC
Entity Type:Organization
Organization Name:THE PROGRESSIVE INTERVENTION NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:912-281-6126
Mailing Address - Street 1:802 EADS ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-2124
Mailing Address - Country:US
Mailing Address - Phone:912-281-6126
Mailing Address - Fax:
Practice Address - Street 1:802 EADS ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-2124
Practice Address - Country:US
Practice Address - Phone:912-281-6126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005208251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health