Healthcare Provider Details

I. General information

NPI: 1336463744
Provider Name (Legal Business Name): SALEM COUNSELING AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GRAND CENTRAL BLVD SUITE 107
POOLER GA
31322-4148
US

IV. Provider business mailing address

113 VILLAGE LAKE DR
POOLER GA
31322-2147
US

V. Phone/Fax

Practice location:
  • Phone: 912-308-8318
  • Fax: 912-748-3847
Mailing address:
  • Phone: 912-308-8318
  • Fax: 912-748-3847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW002511
License Number StateGA

VIII. Authorized Official

Name: STEPHANIE H WARREN
Title or Position: PRESIDENT/OWNER
Credential: LCSW
Phone: 912-308-8318