Provider Demographics
NPI:1548737406
Name:LAGOM COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:LAGOM COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST AND OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:706-340-6944
Mailing Address - Street 1:119 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3462
Mailing Address - Country:US
Mailing Address - Phone:706-340-6944
Mailing Address - Fax:
Practice Address - Street 1:119 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-3462
Practice Address - Country:US
Practice Address - Phone:706-340-6944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health