Our Space Clubhouse

NPI #1225368640 in Cuthbert, Georgia

Provider Information

NPI Number: 1225368640
Entity Type: Organization
Organization Name: Our Space Clubhouse
Subpart: Yes (part of a larger organization)
Parent Organization: NEW HORIZONS COMMUNITY SERVICE BOARD
Primary Specialty: Social Worker - Clinical
Enumeration Date: Jan 7, 2010
Last Updated: Jan 7, 2010

Practice Location

Address: 644 BLAKELY ST
City: Cuthbert
State: Georgia
ZIP Code: 39840-5325
Phone: (229) 732-5050

Authorized Official

Name: PERRY ALEXANDER
Title: CEO
Phone: (706) 596-5757

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X	Primary

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