Provider Demographics
NPI:1861774143
Name:GEORGIA CENTER FOR OCD & ANXIETY
Entity type:Organization
Organization Name:GEORGIA CENTER FOR OCD & ANXIETY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-424-5888
Mailing Address - Street 1:188 S MILLEDGE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-5661
Mailing Address - Country:US
Mailing Address - Phone:706-425-2809
Mailing Address - Fax:678-302-0196
Practice Address - Street 1:188 S MILLEDGE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-5661
Practice Address - Country:US
Practice Address - Phone:706-425-2809
Practice Address - Fax:678-302-0196
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENEWAL COUNSELING & CONSULTING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003451103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty