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NPI Code Detail

MEDICARE: CHARLES R HASTINGS LPC

MEDICARE: CHARLES R HASTINGS LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor000619GA

General Provider Information

NPI Number : 1164421087
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES R HASTINGS LPC
Provider Business Mailing Address
First Line : PO BOX 3229
Second Line :
City : VALDOSTA
State : GA
Zip : 31604-3229
Country : US
Telephone Number : 229-244-4200
Fax Number : 229-244-4995
Provider Business Practice Location Address
First Line : 3541 N CROSSING CIR
Second Line :
City : VALDOSTA
State : GA
Zip : 31602-1019
Country : US
Telephone Number : 229-244-4200
Fax Number : 229-244-4995
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 07/08/2007

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