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General NPI Number Information
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NPI Number | 1437805579
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Entity Type | Organization
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Legal Business Name | BIG UMBRELLA COUNSELING
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 6959 HACKLEBARNEY RD
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City | BLACKSHEAR
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State | GA
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Zip | 31516-4692
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Country | US
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Telephone | 912-278-1239
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1884
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City | WAYCROSS
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State | GA
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Zip | 31502-1884
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Country | US
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Telephone | 912-590-2981
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | JONATON MICHAEL PRYOR
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Credential | LPC
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Telephone | 912-278-1239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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