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319 Old Salem Rd Mineral Bluff GA 30559-2388 | |
| (678) 313-7230 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 319 Old Salem Rd, Mineral Bluff, Georgia |
| Authorized Official Name and Position | Herschel Bretten Smith (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 6783137230 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
319 Old Salem Rd Mineral Bluff GA 30559-2388 Ph: (678) 313-7230 | 319 Old Salem Rd Mineral Bluff GA 30559-2388 Ph: (678) 313-7230 |
| NPI Number | 1861136731 |
|---|---|
| Provider Enumeration Date | 04/26/2022 |
| Last Update Date | 04/28/2022 |
| Certification Date | 04/28/2022 |
| Medicare PECOS PAC ID | 1355791328 |
|---|---|
| Medicare Enrollment ID | O20240103002464 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861136731 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Herschel Bretten Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235734831 PECOS PAC ID: 4385832062 Enrollment ID: I20240103002541 |