Healthcare Provider Details

I. General information

NPI: 1013277623
Provider Name (Legal Business Name): ANODYNE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 1ST ST SE
MOULTRIE GA
31768-5508
US

IV. Provider business mailing address

600 1ST ST SE
MOULTRIE GA
31768-5508
US

V. Phone/Fax

Practice location:
  • Phone: 229-985-8452
  • Fax: 229-890-8430
Mailing address:
  • Phone: 229-985-8452
  • Fax: 229-890-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002205
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003604
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT001144
License Number StateGA

VIII. Authorized Official

Name: DR. C YVONNE COX
Title or Position: OWNER
Credential: PH.D.
Phone: 229-985-8452