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General NPI Number Information
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NPI Number | 1518279793
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Entity Type | Organization
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Legal Business Name | EAST GEORGIA COUNSELING SERVICES, INC.
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Dates
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Enumeration Date | 07/05/2010
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 125 N COLLEGE ST
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City | STATESBORO
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State | GA
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Zip | 30458-5387
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Country | US
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Telephone | 912-764-7785
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Fax | 912-764-6977
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Provider Business Mailing Address
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Address Line | PO BOX 1681
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City | STATESBORO
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State | GA
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Zip | 30459-1681
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Country | US
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Telephone | 912-764-7785
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Fax | 912-764-6977
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Authorized Official
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Title or Position | CEO
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Name | MS. KIM S HULSEY
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Credential | LCSW
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Telephone | 912-764-7785
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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 | CSW000778
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License Number State | GA
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