Provider Demographics
NPI:1306216148
Name:CAROLYN S. METHENY, LLC
Entity Type:Organization
Organization Name:CAROLYN S. METHENY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:METHENY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-210-2767
Mailing Address - Street 1:3150 PERIMETER PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-5797
Mailing Address - Country:US
Mailing Address - Phone:706-210-2767
Mailing Address - Fax:706-210-4842
Practice Address - Street 1:3150 PERIMETER PKWY STE 110
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-5797
Practice Address - Country:US
Practice Address - Phone:706-210-2767
Practice Address - Fax:706-210-4842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006687251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health