Provider Demographics
NPI:1922292002
Name:PIEDMONT COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:PIEDMONT COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPERE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MAC
Authorized Official - Phone:478-477-2220
Mailing Address - Street 1:544 MULBERRY ST STE 305
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8284
Mailing Address - Country:US
Mailing Address - Phone:478-477-2220
Mailing Address - Fax:478-477-2219
Practice Address - Street 1:117 PARKWOOD AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5018
Practice Address - Country:US
Practice Address - Phone:478-477-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2650251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA703358288AMedicaid