=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619433109
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KARIS COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2019
-----------------------------------------------------
Last Update Date | 02/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1551 JENNINGS MILL RD UNIT 3200A
-----------------------------------------------------
City | WATKINSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30677-7282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 762-499-3333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1551 JENNINGS MILL RD UNIT 3200A
-----------------------------------------------------
City | WATKINSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30677-7282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 762-499-3333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | MRS. REBECA GILBERT
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 762-499-3333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------