Healthcare Provider Details

I. General information

NPI: 1609323138
Provider Name (Legal Business Name): GA COUNSELING GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W MORING ST
SWAINSBORO GA
30401-3000
US

IV. Provider business mailing address

204 WEST MORNING ST
SWAINSBORO GA
30401
US

V. Phone/Fax

Practice location:
  • Phone: 800-469-0492
  • Fax:
Mailing address:
  • Phone: 800-469-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NAKIA S PHILLIPS
Title or Position: CEO
Credential:
Phone: 800-469-0492