Provider Demographics
NPI:1679055800
Name:SAFE TO SHORE COUNSELING
Entity Type:Organization
Organization Name:SAFE TO SHORE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JEROME
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-687-1105
Mailing Address - Street 1:211 THORNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0296
Mailing Address - Country:US
Mailing Address - Phone:912-687-1105
Mailing Address - Fax:
Practice Address - Street 1:134 N MAIN ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5753
Practice Address - Country:US
Practice Address - Phone:912-687-1105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010358101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty