MEDICARE: SYLACAUGA 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1669050431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYLACAUGA COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	13 WESTERN AVE
Second Line	:
City	:	SYLACAUGA
State	:	AL
Zip	:	35150-2939
Country	:	US
Telephone Number	:	256-626-8095
Fax Number	:	844-605-1912

Provider Business Practice Location Address
First Line	:	13 WESTERN AVE
Second Line	:
City	:	SYLACAUGA
State	:	AL
Zip	:	35150-2939
Country	:	US
Telephone Number	:	256-626-8095
Fax Number	:	844-605-1912

Authorized Official
Title or Position	:	OWNER
Name	:	AUDRIE CAROLINE CARMACK AARON
Credential	:	LICSW
Telephone Number	:	256-267-4746

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	03/31/2021

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