Provider Demographics
NPI:1912284084
Name:WELLSPRING COUNSELING NORTH GEORGIA LLC
Entity Type:Organization
Organization Name:WELLSPRING COUNSELING NORTH GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:866-714-1224
Mailing Address - Street 1:800 OLD DAWSON VILLAGE RD E
Mailing Address - Street 2:STE 010
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-3816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 OLD DAWSON VILLAGE RD E
Practice Address - Street 2:STE 010
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-3816
Practice Address - Country:US
Practice Address - Phone:866-714-1224
Practice Address - Fax:866-718-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty