Provider Demographics
NPI:1336656578
Name:GEORBEA ENTERPRISES LLC
Entity Type:Organization
Organization Name:GEORBEA ENTERPRISES LLC
Other - Org Name:LEGACY COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUNDRA
Authorized Official - Middle Name:SIMMONS
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-342-2788
Mailing Address - Street 1:1038 BREEZE WAY AVE NE
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:GA
Mailing Address - Zip Code:31331-6511
Mailing Address - Country:US
Mailing Address - Phone:912-342-2788
Mailing Address - Fax:877-408-8199
Practice Address - Street 1:15938 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:GA
Practice Address - Zip Code:31331-3706
Practice Address - Country:US
Practice Address - Phone:912-342-2788
Practice Address - Fax:877-408-8199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORBEA ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-09
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008947101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003201308AMedicaid