| Tara Pettit Deloach Llc | |
|
930 Stevens Creek Rd Augusta GA 30907-3200 | |
| (706) 343-3661 | |
| Not Available |
| Full Name | Tara Pettit Deloach Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 930 Stevens Creek Rd, Augusta, Georgia |
| Authorized Official Name and Position | Tara Pettit Deloach (OWNER) |
| Authorized Official Contact | 7063433661 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tara Pettit Deloach Llc 930 Stevens Creek Rd Augusta GA 30907-3200 Ph: (706) 343-3661 | Tara Pettit Deloach Llc 930 Stevens Creek Rd Augusta GA 30907-3200 Ph: (706) 343-3661 |
| NPI Number | 1124897145 |
|---|---|
| Provider Enumeration Date | 01/02/2024 |
| Last Update Date | 01/02/2024 |
| Certification Date | 01/02/2024 |
| Medicare PECOS PAC ID | 2466896238 |
|---|---|
| Medicare Enrollment ID | O20240220002952 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124897145 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Tara Pettit Deloach |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1790002947 PECOS PAC ID: 3375987142 Enrollment ID: I20240220003175 |
Breakthrough Counseling, Coaching And Consulting Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2903 Galahad Way, Augusta, GA 30909 Phone: 404-496-4614 Fax: 866-923-0754 | |
Samantha L Amses Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 211 Pleasant Home Rd Ste G1, Augusta, GA 30907 Phone: 908-433-4484 Fax: 706-364-4589 | |
Perez Counseling And Consulting Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1051 Sims Dr, Augusta, GA 30909 Phone: 706-589-0914 | |
Living-in-care Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 716 5th St, Augusta, GA 30901 Phone: 912-605-6167 | |