Provider Demographics
NPI:1184830200
Name:WHITE WILLOW COUNSELING AND RECOVERY CENTER
Entity Type:Organization
Organization Name:WHITE WILLOW COUNSELING AND RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:DWYER
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:MED,NCC, LPC, CAADC
Authorized Official - Phone:912-662-0605
Mailing Address - Street 1:7505 WATERS AVE
Mailing Address - Street 2:STE F6
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3825
Mailing Address - Country:US
Mailing Address - Phone:912-662-0605
Mailing Address - Fax:
Practice Address - Street 1:7505 WATERS AVE
Practice Address - Street 2:STE F6
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3825
Practice Address - Country:US
Practice Address - Phone:912-662-0605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006329Medicaid