Provider Demographics
NPI:1811644677
Name:FOUNTAIN CITY COUNSELING SERVICES
Entity type:Organization
Organization Name:FOUNTAIN CITY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, CCMHC
Authorized Official - Phone:706-580-9122
Mailing Address - Street 1:2751 SAWGRASS LN
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-2038
Mailing Address - Country:US
Mailing Address - Phone:706-580-9122
Mailing Address - Fax:
Practice Address - Street 1:1661 13TH ST STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3844
Practice Address - Country:US
Practice Address - Phone:706-580-4868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty