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General NPI Number Information
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NPI Number | 1962863449
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Entity Type | Organization
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Legal Business Name | CATOMA COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 03/11/2016
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Last Update Date | 03/11/2016
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Provider Practice Location Address
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Address Line | 817 GROGAN ST SUITE 105
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City | LAVONIA
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State | GA
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Zip | 30553-1875
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Country | US
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Telephone | 706-356-0333
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Fax |
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Provider Business Mailing Address
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Address Line | 817 GROGAN ST SUITE 105
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City | LAVONIA
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State | GA
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Zip | 30553-1875
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Country | US
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Telephone | 706-356-0333
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Fax |
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Authorized Official
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Title or Position | SENIOR PARTNER
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Name | MR. JOEL HERMAN GIBSON JR.
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Credential | M.ED., LPC
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Telephone | 706-356-0333
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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 | LPC008396
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License Number State | GA
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