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NPI Code Detail

MEDICARE: FAD COUNSELING SERVICES LLC

MEDICARE: FAD COUNSELING SERVICES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1164856829
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAD COUNSELING SERVICES LLC
Provider Business Mailing Address
First Line : PO BOX 72
Second Line :
City : WASHINGTON
State : GA
Zip : 30673-0072
Country : US
Telephone Number : 706-678-5667
Fax Number : 888-495-7489
Provider Business Practice Location Address
First Line : 311 SPRING ST
Second Line :
City : WASHINGTON
State : GA
Zip : 30673-1717
Country : US
Telephone Number : 706-678-5667
Fax Number : 888-495-7489
Authorized Official
Title or Position : OWNER
Name : MR. FULANI AREKA DOUGHTY
Credential : LPC, NCC, CRC, CAADC
Telephone Number : 706-678-5667
Provider Enumeration Date : 08/29/2013
Last Update Date : 08/29/2013

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1497913073 — MR. FULANI AREKA DOUGHTY LPC, NCC, CRC, CAADC
Practice Location Address:
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1619961695 — HOSPITAL AUTHORITY OF WILKES COUNTY
Practice Location Address:
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Directions to “FAD COUNSELING SERVICES LLC ” Practice Location

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