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General NPI Number Information
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NPI Number | 1801273354
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Entity Type | Organization
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Legal Business Name | REFOCUS COUNSELING AND CONSULTING SERVICES, LLC
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 810 W GRADY ST
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City | STATESBORO
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State | GA
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Zip | 30458-0796
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Country | US
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Telephone | 912-687-6422
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1484
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City | STATESBORO
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State | GA
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Zip | 30459-1484
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Country | US
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Telephone | 912-687-6422
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MS. PAULETTE CHAVERS
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Credential |
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Telephone | 912-687-6422
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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 | LPC007564
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License Number State | GA
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