Healthcare Provider Details

I. General information

NPI: 1174038095
Provider Name (Legal Business Name): CAMDEN BEHAVIORAL WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 LINDSEY LN STE C
SAINT MARYS GA
31558-1725
US

IV. Provider business mailing address

88 LINDSEY LN STE C
SAINT MARYS GA
31558-1725
US

V. Phone/Fax

Practice location:
  • Phone: 912-825-8488
  • Fax: 912-341-6794
Mailing address:
  • Phone: 912-825-8488
  • Fax: 903-487-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MOLLY MCCUE
Title or Position: THERAPIST
Credential: LPC
Phone: 912-825-8488