Healthcare Provider Details

I. General information

NPI: 1245958065
Provider Name (Legal Business Name): CENTERPOINT COUNSELING & CLINICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 CHATTAHOOCHEE WINDS DR
DEMOREST GA
30535-3200
US

IV. Provider business mailing address

122 CHATTAHOOCHEE WINDS DR
DEMOREST GA
30535-3200
US

V. Phone/Fax

Practice location:
  • Phone: 706-768-1233
  • Fax:
Mailing address:
  • Phone: 706-768-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: JILL A HUGHES
Title or Position: CEO
Credential: LCSW
Phone: 706-768-1233