Provider Demographics
NPI:1942355888
Name:SAPELO COUNSELING CENTER
Entity Type:Organization
Organization Name:SAPELO COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:912-682-2709
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-0373
Mailing Address - Country:US
Mailing Address - Phone:912-682-2709
Mailing Address - Fax:912-764-5661
Practice Address - Street 1:106 OAK ST STE A
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0988
Practice Address - Country:US
Practice Address - Phone:912-682-2709
Practice Address - Fax:912-764-5661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty