Provider Demographics
NPI:1669651212
Name:SAMARITAN COUNSELING CENTER OF SOUTHWEST GEORGIA, INC.
Entity Type:Organization
Organization Name:SAMARITAN COUNSELING CENTER OF SOUTHWEST GEORGIA, INC.
Other - Org Name:THE SAMARITAN COUNSELING CENTER OF SOUTHWEST GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:229-243-1633
Mailing Address - Street 1:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39818-1276
Mailing Address - Country:US
Mailing Address - Phone:229-243-1633
Mailing Address - Fax:229-243-9446
Practice Address - Street 1:208 S BROAD ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817-3616
Practice Address - Country:US
Practice Address - Phone:229-243-1633
Practice Address - Fax:229-243-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004327101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty