Healthcare Provider Details

I. General information

NPI: 1518615632
Provider Name (Legal Business Name): THERAPY CENTER COUNSELING & CONSULTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 GREEN CIRCLE
VALDOSTA GA
31602-2885
US

IV. Provider business mailing address

1817 GREEN CIRCLE
VALDOSTA GA
31602-2885
US

V. Phone/Fax

Practice location:
  • Phone: 229-244-9688
  • Fax:
Mailing address:
  • Phone:
  • 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 Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA COSEY
Title or Position: OWNER
Credential:
Phone: 229-292-4944