=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245573344
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER COUNSELING SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2013
-----------------------------------------------------
Last Update Date | 01/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 318 S WELBORN ST SUITE C
-----------------------------------------------------
City | HINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31313-3127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-332-5145
-----------------------------------------------------
Fax | 912-480-9732
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 318 S WELBORN STREET SUITE C
-----------------------------------------------------
City | HINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-332-5145
-----------------------------------------------------
Fax | 912-480-9732
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GLORIA HARRIS DAUGHTERY
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 912-332-5145
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC005336
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------