Healthcare Provider Details

I. General information

NPI: 1275290967
Provider Name (Legal Business Name): AGAPE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 12TH ST STE 525
COLUMBUS GA
31901-2462
US

IV. Provider business mailing address

233 12TH ST STE 525
COLUMBUS GA
31901-2462
US

V. Phone/Fax

Practice location:
  • Phone: 888-829-0897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
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: REBECCA CLARK
Title or Position: OWNER
Credential: LICSW, PHD
Phone: 270-535-2545