Healthcare Provider Details

I. General information

NPI: 1033969985
Provider Name (Legal Business Name): YAMIL JOSE SANTANA LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 TELFAIR ST
AUGUSTA GA
30901-2590
US

IV. Provider business mailing address

610 VISTA DR
GROVETOWN GA
30813-5607
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-0600
  • Fax:
Mailing address:
  • Phone: 706-619-7994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014589
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: