Provider Demographics
NPI:1760188155
Name:COMPASSIONATE COUNSELING & SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:COMPASSIONATE COUNSELING & SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TABRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORPREW
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-682-1383
Mailing Address - Street 1:101 BLUE MOON XING
Mailing Address - Street 2:SUITE 3, UNIT 114
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9798
Mailing Address - Country:US
Mailing Address - Phone:912-682-1383
Mailing Address - Fax:912-219-2285
Practice Address - Street 1:240 CREEKSIDE CIR
Practice Address - Street 2:
Practice Address - City:ELLABELL
Practice Address - State:GA
Practice Address - Zip Code:31308-7231
Practice Address - Country:US
Practice Address - Phone:912-682-1383
Practice Address - Fax:912-219-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC0113110OtherLICENSED PROFESSIONAL COUNSELOR