| Counseling Services Of Lagrange, Inc. | |
|
610 Ridley Ave Lagrange GA 30240-2236 | |
| (706) 884-5050 | |
| (706) 884-5056 |
| Full Name | Counseling Services Of Lagrange, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 610 Ridley Ave, Lagrange, Georgia |
| Authorized Official Name and Position | Shannon Keith Dunlap (OWNER/DIRECTOR) |
| Authorized Official Contact | 7068845050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Counseling Services Of Lagrange, Inc. 610 Ridley Ave Lagrange GA 30240-2236 Ph: (706) 884-5050 | Counseling Services Of Lagrange, Inc. 610 Ridley Ave Lagrange GA 30240-2236 Ph: (706) 884-5050 |
| NPI Number | 1790197804 |
|---|---|
| Provider Enumeration Date | 05/22/2014 |
| Last Update Date | 06/29/2015 |
| Medicare PECOS PAC ID | 0446474639 |
|---|---|
| Medicare Enrollment ID | O20140609001622 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790197804 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY003497 (Georgia) | Primary |
| Provider Name | Shannon K Dunlap |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194950857 PECOS PAC ID: 1254555444 Enrollment ID: I20140609001710 |
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