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General NPI Number Information
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NPI Number | 1811762933
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Entity Type | Organization
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Legal Business Name | THIRD ACT COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 598 S MILLEDGE AVE STE 5
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City | ATHENS
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State | GA
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Zip | 30605-1262
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Country | US
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Telephone | 706-389-4509
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 612
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City | ATHENS
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State | GA
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Zip | 30603-0612
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Country | US
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Telephone | 706-389-4509
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAIGE CAMPBELL
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Credential |
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Telephone | 706-389-4509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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