Provider Demographics
NPI:1851689822
Name:AUGUSTA COUNSELING CENTER, PLC
Entity Type:Organization
Organization Name:AUGUSTA COUNSELING CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARION
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-943-0409
Mailing Address - Street 1:201B ROSSER AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-3540
Mailing Address - Country:US
Mailing Address - Phone:540-943-0409
Mailing Address - Fax:540-943-7912
Practice Address - Street 1:201B ROSSER AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3540
Practice Address - Country:US
Practice Address - Phone:540-943-0409
Practice Address - Fax:540-943-7912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040047451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty