Healthcare Provider Details

I. General information

NPI: 1689245789
Provider Name (Legal Business Name): BETHANY ANNE BARCOMB LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 WHEELER RD STE 365
AUGUSTA GA
30909-6549
US

IV. Provider business mailing address

3633 WHEELER RD STE 365
AUGUSTA GA
30909-6549
US

V. Phone/Fax

Practice location:
  • Phone: 706-432-6866
  • Fax: 706-432-8775
Mailing address:
  • Phone: 518-593-5827
  • Fax: 706-432-8775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC013977
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: