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General NPI Number Information
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NPI Number | 1508304932
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Entity Type | Organization
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Legal Business Name | COMMUNITY PSYCHOTHERAPY AND ADDICTION COUNSELING, LLC
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 341 MARGIE DR STE 3A
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City | WARNER ROBINS
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State | GA
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Zip | 31088
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Country | US
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Telephone | 478-832-9442
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Fax | 229-299-0993
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Provider Business Mailing Address
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Address Line | 401 OBRIEN DR
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City | KATHLEEN
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State | GA
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Zip | 31047-5351
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Country | US
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Telephone | 478-832-9442
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Fax | 229-299-0993
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Authorized Official
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Title or Position | OWNER
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Name | LEE R CHAMBERS
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Credential | LCSW
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Telephone | 478-832-9442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | 17008045
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW005857
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License Number State | GA
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