Healthcare Provider Details

I. General information

NPI: 1821461005
Provider Name (Legal Business Name): RESOLUTION COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 WYNNTON RD STE 109
COLUMBUS GA
31906-5710
US

IV. Provider business mailing address

1300 WYNNTON RD STE 109
COLUMBUS GA
31906-5710
US

V. Phone/Fax

Practice location:
  • Phone: 706-641-2414
  • Fax: 706-641-2408
Mailing address:
  • Phone: 706-641-2414
  • Fax: 706-641-2408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC005656
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLPC005656
License Number StateGA

VIII. Authorized Official

Name: RUDOLPH MARTIN
Title or Position: CEO
Credential: LPC
Phone: 334-614-0959