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General NPI Number Information
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NPI Number | 1245748771
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Entity Type | Organization
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Legal Business Name | EMANUEL COUNSELING SERVICES, INC
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 05/13/2019
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Provider Practice Location Address
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Address Line | 105 WARREN AVE
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City | SWAINSBORO
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State | GA
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Zip | 30401-3645
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Country | US
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Telephone | 478-289-8147
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Fax | 478-289-8148
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Provider Business Mailing Address
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Address Line | 105 WARREN AVE
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City | SWAINSBORO
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State | GA
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Zip | 30401-3645
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Country | US
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Telephone | 478-289-8147
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Fax | 478-289-8148
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEHIA COCHRAN
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Credential | LPC
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Telephone | 478-289-8147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 36774
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License Number State | GA
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