Healthcare Provider Details

I. General information

NPI: 1790146900
Provider Name (Legal Business Name): AUGUSTA COUNSELING PROFESSIONALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 PROFESSIONAL PKWY
AUGUSTA GA
30907-6529
US

IV. Provider business mailing address

601 N BELAIR SQ STE 3
EVANS GA
30809-4322
US

V. Phone/Fax

Practice location:
  • Phone: 706-833-0780
  • Fax: 844-880-3086
Mailing address:
  • Phone: 706-833-0780
  • Fax: 844-880-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC008833
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CASSIDY NICOLE THIGPEN
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 706-833-0780