Provider Demographics
NPI:1053012666
Name:FARLEY, RICK
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:FARLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 PRESERVE TRL
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:GA
Mailing Address - Zip Code:31565-2484
Mailing Address - Country:US
Mailing Address - Phone:803-634-3485
Mailing Address - Fax:
Practice Address - Street 1:1 YOUTH ESTATE DR # 99
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-7206
Practice Address - Country:US
Practice Address - Phone:912-267-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician