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General NPI Number Information
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NPI Number | 1386025641
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Entity Type | Organization
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Legal Business Name | WHOLISTIC COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 3624 PEACH ORCHARD RD
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City | AUGUSTA
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State | GA
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Zip | 30906-9436
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Country | US
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Telephone | 478-401-4748
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Fax | 478-401-4749
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Provider Business Mailing Address
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Address Line | 3624 PEACH ORCHARD RD
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City | AUGUSTA
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State | GA
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Zip | 30906-9436
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Country | US
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Telephone | 478-401-4748
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Fax | 478-401-4749
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Authorized Official
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Title or Position | OWNER
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Name | SHUNTOYA CHATMAN
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Credential | LCSW
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Telephone | 478-401-4748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | CSW005428
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CSW005428
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License Number State | GA
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