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General NPI Number Information
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NPI Number | 1336463744
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Entity Type | Organization
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Legal Business Name | SALEM COUNSELING AND CONSULTING, LLC
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 105 GRAND CENTRAL BLVD SUITE 107
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City | POOLER
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State | GA
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Zip | 31322-4148
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Country | US
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Telephone | 912-308-8318
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Fax | 912-748-3847
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Provider Business Mailing Address
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Address Line | 113 VILLAGE LAKE DR
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City | POOLER
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State | GA
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Zip | 31322-2147
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Country | US
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Telephone | 912-308-8318
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Fax | 912-748-3847
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | STEPHANIE H WARREN
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Credential | LCSW
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Telephone | 912-308-8318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW002511
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License Number State | GA
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