Provider Demographics
NPI:1245696582
Name:WALNUT HILL COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:WALNUT HILL COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:229-563-7064
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-0164
Mailing Address - Country:US
Mailing Address - Phone:229-563-6947
Mailing Address - Fax:229-549-6050
Practice Address - Street 1:223 2ND ST E
Practice Address - Street 2:SUITE B
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4493
Practice Address - Country:US
Practice Address - Phone:229-563-6947
Practice Address - Fax:229-549-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0045081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty