Provider Demographics
NPI:1518279793
Name:EAST GEORGIA COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:EAST GEORGIA COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HULSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:912-764-7785
Mailing Address - Street 1:PO BOX 1681
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-1681
Mailing Address - Country:US
Mailing Address - Phone:912-764-7785
Mailing Address - Fax:912-764-6977
Practice Address - Street 1:125 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5387
Practice Address - Country:US
Practice Address - Phone:912-764-7785
Practice Address - Fax:912-764-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-05
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0007781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00957877AMedicaid
GA80BBFMKMedicare PIN