Provider Demographics
NPI:1508290099
Name:PINNACLE COUNSELING SERVICES
Entity Type:Organization
Organization Name:PINNACLE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:TISON
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:229-244-5533
Mailing Address - Street 1:1205 BAYTREE ROAD #8
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602
Mailing Address - Country:US
Mailing Address - Phone:229-244-5533
Mailing Address - Fax:229-253-9066
Practice Address - Street 1:1205 BAYTREE ROAD #8
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602
Practice Address - Country:US
Practice Address - Phone:229-244-5533
Practice Address - Fax:229-253-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004567251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003127123Medicaid