Healthcare Provider Details

I. General information

NPI: 1285732784
Provider Name (Legal Business Name): ATHENS PASTORAL COUNSELING DBA SAMARITAN COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 N LUMPKIN ST
ATHENS GA
30601-2744
US

IV. Provider business mailing address

455 N LUMPKIN ST
ATHENS GA
30601-2744
US

V. Phone/Fax

Practice location:
  • Phone: 706-369-7911
  • Fax: 706-208-9509
Mailing address:
  • Phone: 706-369-7911
  • Fax: 706-208-9509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS G. CAMP
Title or Position: EXECUTIVE DIRECTOR
Credential: M.DIV., M.S.
Phone: 706-369-7911