MEDICARE: FOUR THIRTEEN COUNSELING SERVICES, LLC

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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1235887589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR THIRTEEN COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 8224
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31908-8224
Country	:	US
Telephone Number	:	205-690-0651
Fax Number	:

Provider Business Practice Location Address
First Line	:	3059 EDGEWOOD CT
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-2593
Country	:	US
Telephone Number	:	205-240-0498
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MRS. EVELYN NICOLE ROBERTS
Credential	:	LCSW
Telephone Number	:	205-240-0498

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	08/17/2022

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