Provider Demographics
NPI:1578093712
Name:SOUTHERN COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHERN COUNSELING SERVICES, LLC
Other - Org Name:SOUTHERN COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:912-286-3208
Mailing Address - Street 1:437 W PARKER ST
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-0605
Mailing Address - Country:US
Mailing Address - Phone:912-705-0858
Mailing Address - Fax:912-705-6423
Practice Address - Street 1:437 W PARKER ST
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0605
Practice Address - Country:US
Practice Address - Phone:912-705-0858
Practice Address - Fax:912-705-6423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC0082101YA0400X, 101YM0800X
GA0338752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073902938OtherNPPES
GA003189544AMedicaid