Provider Demographics
NPI:1508304932
Name:COMMUNITY PSYCHOTHERAPY AND ADDICTION COUNSELING, LLC
Entity Type:Organization
Organization Name:COMMUNITY PSYCHOTHERAPY AND ADDICTION COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:478-832-9442
Mailing Address - Street 1:401 OBRIEN DR
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-5351
Mailing Address - Country:US
Mailing Address - Phone:478-832-9442
Mailing Address - Fax:229-299-0993
Practice Address - Street 1:341 MARGIE DR STE 3A
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-832-9442
Practice Address - Fax:229-299-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X, 103TB0200X, 103TC1900X, 103TA0400X, 103TB0200X, 103TC1900X
GA17008045103TP2701X, 103TP2701X
GACSW0058571041C0700X, 1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003177727EMedicaid
GA9453675OtherAETNA
GA4658124OtherCIGNA