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3170 Skinner Mill Rd Augusta GA 30909-5012 | |
| (706) 309-0800 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 3170 Skinner Mill Rd, Augusta, Georgia |
| Authorized Official Name and Position | Tendra L Statom (LICENSED PROFESSIONAL COUNSELOR/CEO) |
| Authorized Official Contact | 7063090800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3170 Skinner Mill Rd Augusta GA 30909-5012 Ph: (706) 309-0800 | 3170 Skinner Mill Rd Augusta GA 30909-5012 Ph: (706) 309-0800 |
| NPI Number | 1164179800 |
|---|---|
| Provider Enumeration Date | 03/02/2022 |
| Last Update Date | 05/30/2022 |
| Certification Date | 05/30/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164179800 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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