Healthcare Provider Details

I. General information

NPI: 1205126943
Provider Name (Legal Business Name): AR PSYCHIATRIC & COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 N OAK ST EXT BLDG D
VALDOSTA GA
31605-1066
US

IV. Provider business mailing address

3312 N OAK ST EXT BLDG D
VALDOSTA GA
31605-1066
US

V. Phone/Fax

Practice location:
  • Phone: 229-244-2030
  • Fax: 229-244-2038
Mailing address:
  • Phone: 229-244-2030
  • Fax: 229-244-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANIL KUMAR GUPTA
Title or Position: OWNER
Credential: M.D.
Phone: 229-244-2030