Healthcare Provider Details

I. General information

NPI: 1487564910
Provider Name (Legal Business Name): GENTLE JOURNEY PLAY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 WALKER ST
AUGUSTA GA
30901-2462
US

IV. Provider business mailing address

431 WALKER ST
AUGUSTA GA
30901-2462
US

V. Phone/Fax

Practice location:
  • Phone: 803-232-8929
  • Fax:
Mailing address:
  • Phone: 803-232-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CAILA LENE
Title or Position: OWNER
Credential: LPC, RPT
Phone: 803-232-8929