Provider Demographics
NPI:1679063440
Name:COLUMBUS COUSELING ASSOCIATES LLC
Entity Type:Organization
Organization Name:COLUMBUS COUSELING ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOVAR MURILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-327-1222
Mailing Address - Street 1:7381 LULLWATER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-1932
Mailing Address - Country:US
Mailing Address - Phone:706-327-1222
Mailing Address - Fax:706-327-1444
Practice Address - Street 1:4 BRADLEY PARK CT STE 1H
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3634
Practice Address - Country:US
Practice Address - Phone:706-327-1222
Practice Address - Fax:706-327-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006333101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty