Healthcare Provider Details

I. General information

NPI: 1538415765
Provider Name (Legal Business Name): CHRISTOPHER RANDALL CARKHUM LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 BELLEMEADE DR
AUGUSTA GA
30906-3101
US

IV. Provider business mailing address

3110 BELLEMEADE DR
AUGUSTA GA
30906-3101
US

V. Phone/Fax

Practice location:
  • Phone: 706-814-0005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number232361
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number736484
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number204785
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC0055
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC006574
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: