Provider Demographics
NPI:1922633692
Name:712 Q.A.C.C. COUNSELING FOR THE SOUL
Entity Type:Organization
Organization Name:712 Q.A.C.C. COUNSELING FOR THE SOUL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:678-744-5603
Mailing Address - Street 1:PO BOX 7174
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31418-7174
Mailing Address - Country:US
Mailing Address - Phone:678-744-5603
Mailing Address - Fax:
Practice Address - Street 1:13051 ABERCORN ST STE B3 526
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-3141
Practice Address - Country:US
Practice Address - Phone:678-744-5603
Practice Address - Fax:877-278-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty