Healthcare Provider Details

I. General information

NPI: 1174478366
Provider Name (Legal Business Name): TCM COUNSELING & TRAINING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COLLEGE CT
FORT VALLEY GA
31030-4402
US

IV. Provider business mailing address

105 COLLEGE CT
FORT VALLEY GA
31030-4402
US

V. Phone/Fax

Practice location:
  • Phone: 478-721-7095
  • Fax:
Mailing address:
  • Phone: 478-721-7095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: TALISHA CARTER-MOODY
Title or Position: OWNER
Credential: CARTER-MOODY
Phone: 478-293-8503