| Joshua Tree Counseling Center, Llc | |
|
2484 Memorial Dr Ste 27 Waycross GA 31503-6336 | |
| (912) 548-2099 | |
| Not Available |
| Full Name | Joshua Tree Counseling Center, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2484 Memorial Dr Ste 27, Waycross, Georgia |
| Authorized Official Name and Position | Theresa Land (OWNER) |
| Authorized Official Contact | 9125482099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Joshua Tree Counseling Center, Llc 815 Orchard Ln Waycross GA 31501-7547 Ph: (912) 548-2099 | Joshua Tree Counseling Center, Llc 2484 Memorial Dr Ste 27 Waycross GA 31503-6336 Ph: (912) 548-2099 |
| NPI Number | 1710525472 |
|---|---|
| Provider Enumeration Date | 12/12/2019 |
| Last Update Date | 12/12/2019 |
| Certification Date | 12/12/2019 |
| Medicare PECOS PAC ID | 5799106712 |
|---|---|
| Medicare Enrollment ID | O20200529002585 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710525472 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Theresa Land |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134644578 PECOS PAC ID: 6608297627 Enrollment ID: I20200529002628 |
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Memorial Satilla Health Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1900 Tebeau St, Waycross, GA 31501 Phone: 912-283-3030 Fax: 912-287-2505 | |
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