Healthcare Provider Details

I. General information

NPI: 1174094726
Provider Name (Legal Business Name): ATHENS COUNSELING & PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HUNTINGTON RD STE 101
ATHENS GA
30606-7205
US

IV. Provider business mailing address

1 HUNTINGTON RD STE 101
ATHENS GA
30606-7205
US

V. Phone/Fax

Practice location:
  • Phone: 706-514-1213
  • Fax: 706-504-9549
Mailing address:
  • Phone: 706-514-1213
  • Fax: 706-504-9549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIELLE ANGELA STAIR
Title or Position: OWNER/OPERATOR
Credential: LCSW
Phone: 706-514-1213