Healthcare Provider Details

I. General information

NPI: 1184844565
Provider Name (Legal Business Name): REDIRECT COUNSELING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 BEMISS RD # A
VALDOSTA GA
31602-3030
US

IV. Provider business mailing address

2031 A BEMISS ROAD
VALDOSTA GA
31602
US

V. Phone/Fax

Practice location:
  • Phone: 229-293-0444
  • Fax: 229-253-0381
Mailing address:
  • Phone: 229-293-0444
  • Fax: 229-253-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number26001
License Number StateGA

VIII. Authorized Official

Name: MRS. DEBRA L MASHBURN
Title or Position: OWNER DIRECTOR
Credential: ICADC, CCS
Phone: 229-293-0444