Southeast Georgia Counseling & Play Therapy, Llc | |
140 Lakes Blvd Kingsland GA 31548-6813 | |
(912) 510-6250 | |
(912) 510-6960 |
Full Name | Southeast Georgia Counseling & Play Therapy, Llc |
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Speciality | Counselor |
Location | 140 Lakes Blvd, Kingsland, Georgia |
Authorized Official Name and Position | Lindsay Bottoms (OWNER) |
Authorized Official Contact | 9125106250 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Southeast Georgia Counseling & Play Therapy, Llc 147 Serenity Farms Rd Woodbine GA 31569-4447 Ph: (912) 510-6250 | Southeast Georgia Counseling & Play Therapy, Llc 140 Lakes Blvd Kingsland GA 31548-6813 Ph: (912) 510-6250 |
NPI Number | 1902576119 |
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Provider Enumeration Date | 09/18/2021 |
Last Update Date | 09/18/2021 |
Certification Date | 09/18/2021 |
Medicare PECOS PAC ID | 7810429115 |
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Medicare Enrollment ID | O20241011000054 |
Identifier | Type | State | Issuer |
---|---|---|---|
1902576119 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
Provider Name | Lindsay Bottoms |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1104388917 PECOS PAC ID: 8729510029 Enrollment ID: I20241011000071 |
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