Provider Demographics
NPI:1700472297
Name:LIVE OAK COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:LIVE OAK COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANNERY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:470-205-2665
Mailing Address - Street 1:213 CECIL WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-7432
Mailing Address - Country:US
Mailing Address - Phone:470-464-6124
Mailing Address - Fax:
Practice Address - Street 1:15 JONESBORO ST STE B
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3161
Practice Address - Country:US
Practice Address - Phone:470-464-6124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health