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General NPI Number Information
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NPI Number | 1588062756
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Entity Type | Organization
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Legal Business Name | TRANSFORMATION 3CS, LLC
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Dates
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Enumeration Date | 12/19/2014
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Last Update Date | 12/19/2014
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Provider Practice Location Address
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Address Line | 3711 EXECUTIVE CENTER DR STE 202 #6
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City | MARTINEZ
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State | GA
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Zip | 30907-0951
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Country | US
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Telephone | 706-750-4275
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Fax | 706-432-9095
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Provider Business Mailing Address
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Address Line | PO BOX 9443
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City | AUGUSTA
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State | GA
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Zip | 30916-9443
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Country | US
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Telephone | 706-750-4275
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Fax | 706-432-9095
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Authorized Official
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Title or Position | CEO
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Name | SANDRA VARNER PHILLLIPS
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Credential | LPC
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Telephone | 706-750-4275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LPC006436
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC006436
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License Number State | GA
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