Provider Demographics
NPI:1144555202
Name:SOUTHEASTERN COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:SOUTHEASTERN COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:OGLESBEE
Authorized Official - Suffix:
Authorized Official - Credentials:EDS,NBCC,LPC
Authorized Official - Phone:912-826-1145
Mailing Address - Street 1:P.O. BOX 667
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-0667
Mailing Address - Country:US
Mailing Address - Phone:912-826-1145
Mailing Address - Fax:912-826-1245
Practice Address - Street 1:812 TOWNE PARK DR., UNIT 400
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-0667
Practice Address - Country:US
Practice Address - Phone:912-826-1145
Practice Address - Fax:912-826-1245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004615101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA600030703OtherMAGELLAN