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General NPI Number Information
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NPI Number | 1508290099
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Entity Type | Organization
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Legal Business Name | PINNACLE COUNSELING SERVICES
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 1205 BAYTREE ROAD #8
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City | VALDOSTA
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State | GA
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Zip | 31602
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Country | US
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Telephone | 229-244-5533
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Fax | 229-253-9066
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Provider Business Mailing Address
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Address Line | 1205 BAYTREE ROAD #8
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City | VALDOSTA
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State | GA
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Zip | 31602
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Country | US
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Telephone | 229-244-5533
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Fax | 229-253-9066
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Authorized Official
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Title or Position | OWER
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Name | MR. LEE TISON WADE
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Credential | LPC
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Telephone | 229-244-5533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 004567
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License Number State | GA
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