| Spbs | |
|
202 W Gordon St Suite D Valdosta GA 31601-4569 | |
| (229) 474-9800 | |
| (229) 515-4443 |
| Full Name | Spbs |
|---|---|
| Speciality | Psychologist |
| Location | 202 W Gordon St, Valdosta, Georgia |
| Authorized Official Name and Position | Twyla Lucinda Mancil (LICENSED PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 3527278679 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spbs 202 W Gordon St Suite D Valdosta GA 31601-4569 Ph: (229) 474-9800 | Spbs 202 W Gordon St Suite D Valdosta GA 31601-4569 Ph: (229) 474-9800 |
| NPI Number | 1164870408 |
|---|---|
| Provider Enumeration Date | 05/26/2016 |
| Last Update Date | 05/26/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164870408 | NPI | - | NPPES |
| 00316809A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY003935 (Georgia) | Primary |
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