Doctor Name: | DR. THOMAS W FORD |
NPI Number: | 1457417792 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | PSY002405 |
Business Practice Address: | 501 Mize Street La Fayette, GA - 307281027 |
Business Phone Number: | 7066385584 |
Business Fax Number: | 7066385585 |
Mailing Address: | Po Box 1027, LA FAYETTE |
State: | GA |
Postal Code: | 307281027 |
Phone Number: | 7066385584 |
Fax Number: | 7066385585 |
NPI Enumeration Date: | 12/29/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC1900X |
License Number: | PSY002405 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Counseling |
Taxonomy Definition: |