Provider Demographics
NPI:1700839735
Name:MCG EAP SERVICES, INC.
Entity Type:Organization
Organization Name:MCG EAP SERVICES, INC.
Other - Org Name:SOUTHERN BEHAVIORAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MIONA
Authorized Official - Middle Name:G
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-742-1464
Mailing Address - Street 1:179 PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2821
Mailing Address - Country:US
Mailing Address - Phone:478-742-1464
Mailing Address - Fax:478-742-1883
Practice Address - Street 1:179 PIERCE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2821
Practice Address - Country:US
Practice Address - Phone:478-742-1464
Practice Address - Fax:478-742-1883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004182101YP2500X
GA000992106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116537069AMedicaid