Healthcare Provider Details

I. General information

NPI: 1922861293
Provider Name (Legal Business Name): COMPASSION THERAPEUTIC COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HUBERT DOLLAR DR
BAINBRIDGE GA
39819-3304
US

IV. Provider business mailing address

102 HUBERT DOLLAR DR
BAINBRIDGE GA
39819-3304
US

V. Phone/Fax

Practice location:
  • Phone: 229-254-3627
  • Fax: 229-389-2877
Mailing address:
  • Phone: 229-254-3627
  • Fax: 229-389-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. CARNEL RENEA JONES
Title or Position: THERAPIST
Credential: LPC
Phone: 229-254-3627