Provider Demographics
NPI:1336463744
Name:SALEM COUNSELING AND CONSULTING, LLC
Entity Type:Organization
Organization Name:SALEM COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:912-308-8318
Mailing Address - Street 1:113 VILLAGE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-2147
Mailing Address - Country:US
Mailing Address - Phone:912-308-8318
Mailing Address - Fax:912-748-3847
Practice Address - Street 1:105 GRAND CENTRAL BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4148
Practice Address - Country:US
Practice Address - Phone:912-308-8318
Practice Address - Fax:912-748-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0025111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty