Provider Demographics
NPI:1467771212
Name:STRICKLAND, TIMOTHY JAY (MED, LPC, MAC,CCS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAY
Last Name:STRICKLAND
Suffix:
Gender:M
Credentials:MED, LPC, MAC,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SW BROAD ST
Mailing Address - Street 2:
Mailing Address - City:METTER
Mailing Address - State:GA
Mailing Address - Zip Code:30439-4433
Mailing Address - Country:US
Mailing Address - Phone:912-515-5026
Mailing Address - Fax:912-785-2008
Practice Address - Street 1:5 SW BROAD ST
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-4433
Practice Address - Country:US
Practice Address - Phone:912-515-5026
Practice Address - Fax:912-785-2008
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA507450101YA0400X
GA005731101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)