MEDICARE: JODE COUNSELING TRAINING AND TREATMENT SERVICES INC

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	LPC005821	GA

General Provider Information

NPI Number	:	1902220536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JODE COUNSELING TRAINING AND TREATMENT SERVICES INC

Provider Business Mailing Address
First Line	:	3555 MERCER UNIVERSITY DR STE 101-6
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31204-4966
Country	:	US
Telephone Number	:	478-471-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	3555 MERCER UNIVERSITY DR
Second Line	:	SUITE 1016
City	:	MACON
State	:	GA
Zip	:	31204-4940
Country	:	US
Telephone Number	:	678-670-9688
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOAN BOJNANSKY
Credential	:
Telephone Number	:	678-788-7400

Provider Enumeration Date	:	02/18/2014
Last Update Date	:	02/18/2014

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