Provider Demographics
NPI:1902576119
Name:SOUTHEAST GEORGIA COUNSELING & PLAY THERAPY, LLC
Entity Type:Organization
Organization Name:SOUTHEAST GEORGIA COUNSELING & PLAY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTTOMS
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPC, RPT
Authorized Official - Phone:912-510-6250
Mailing Address - Street 1:147 SERENITY FARMS RD
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:GA
Mailing Address - Zip Code:31569-4447
Mailing Address - Country:US
Mailing Address - Phone:912-510-6250
Mailing Address - Fax:912-510-6960
Practice Address - Street 1:140 LAKES BLVD
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6813
Practice Address - Country:US
Practice Address - Phone:912-510-6250
Practice Address - Fax:912-510-6960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-18
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty