MEDICARE: FOUNTAIN CITY COUNSELING SERVICES

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1811644677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNTAIN CITY COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	2751 SAWGRASS LN
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-2038
Country	:	US
Telephone Number	:	706-580-9122
Fax Number	:

Provider Business Practice Location Address
First Line	:	1661 13TH ST STE 102
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-3844
Country	:	US
Telephone Number	:	706-580-4868
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	ROCHELLE PETERMANN
Credential	:	MS, LPC, CCMHC
Telephone Number	:	706-580-9122

Provider Enumeration Date	:	03/02/2022
Last Update Date	:	03/02/2022

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Directions to “FOUNTAIN CITY COUNSELING SERVICES ” Practice Location

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