Provider Demographics
NPI:1740301373
Name:GARDEN CITY COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:GARDEN CITY COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TATJANA
Authorized Official - Middle Name:ESTEP
Authorized Official - Last Name:RAYCROFT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:706-833-7601
Mailing Address - Street 1:801 CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-3711
Mailing Address - Country:US
Mailing Address - Phone:706-833-7601
Mailing Address - Fax:706-869-9870
Practice Address - Street 1:801 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-3711
Practice Address - Country:US
Practice Address - Phone:706-833-7601
Practice Address - Fax:706-869-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC001457251S00000X
GA3760251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health