Provider Demographics
NPI:1326188855
Name:CLARKESVILLE COUNSELING & MEDIATION SERVICES, INC
Entity Type:Organization
Organization Name:CLARKESVILLE COUNSELING & MEDIATION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-768-1420
Mailing Address - Street 1:PO BOX 964
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-0017
Mailing Address - Country:US
Mailing Address - Phone:706-768-1420
Mailing Address - Fax:
Practice Address - Street 1:695 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523
Practice Address - Country:US
Practice Address - Phone:706-768-1420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC1459101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty