Provider Demographics
NPI:1245573344
Name:PREMIER COUNSELING SERVICES INC
Entity Type:Organization
Organization Name:PREMIER COUNSELING SERVICES INC
Other - Org Name:PREMIER COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:DAUGHTERY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-332-5145
Mailing Address - Street 1:318 S WELBORN STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313
Mailing Address - Country:US
Mailing Address - Phone:912-332-5145
Mailing Address - Fax:912-480-9732
Practice Address - Street 1:318 S WELBORN ST
Practice Address - Street 2:SUITE C
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3127
Practice Address - Country:US
Practice Address - Phone:912-332-5145
Practice Address - Fax:912-480-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005336101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA603509452BMedicaid