Provider Demographics
NPI:1205126943
Name:AR PSYCHIATRIC & COUNSELING CENTER LLC
Entity type:Organization
Organization Name:AR PSYCHIATRIC & COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-244-2030
Mailing Address - Street 1:3312 N OAK ST EXT BLDG D
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1066
Mailing Address - Country:US
Mailing Address - Phone:229-244-2030
Mailing Address - Fax:229-244-2038
Practice Address - Street 1:3312 N OAK ST EXT BLDG D
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1066
Practice Address - Country:US
Practice Address - Phone:229-244-2030
Practice Address - Fax:229-244-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00934975EMedicaid
GA00934975EMedicaid