Healthcare Provider Details

I. General information

NPI: 1619469665
Provider Name (Legal Business Name): 1ST GEORGIA COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 9TH ST STE 102
COLUMBUS GA
31901-2760
US

IV. Provider business mailing address

191 ARROWHEAD DR
WAVERLY HALL GA
31831-2168
US

V. Phone/Fax

Practice location:
  • Phone: 470-553-9423
  • Fax:
Mailing address:
  • Phone: 470-553-9423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AIMEE HICKS
Title or Position: OWNER
Credential: LPC, PHD, ACC, LCDC
Phone: 470-553-9423