MEDICARE: CHOSEN GENERATION COUNSELING AND CONSULTING, 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	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1598364093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOSEN GENERATION COUNSELING AND CONSULTING, LLC

Provider Business Mailing Address
First Line	:	4923 ARMOUR RD STE 200
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5038
Country	:	US
Telephone Number	:	706-940-2590
Fax Number	:

Provider Business Practice Location Address
First Line	:	4923 ARMOUR RD STE 200
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5038
Country	:	US
Telephone Number	:	706-940-2590
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. CEMINTHIA GRAHAM
Credential	:	LCSW
Telephone Number	:	706-940-2590

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	10/26/2020

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