| Provision Counseling Center Llc | |
|
1776 N Jefferson St Ne Ste B Milledgeville GA 31061-2292 | |
| (478) 414-1946 | |
| (866) 815-6940 |
| Full Name | Provision Counseling Center Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1776 N Jefferson St Ne Ste B, Milledgeville, Georgia |
| Authorized Official Name and Position | Semika Roach (LPC/OWNER) |
| Authorized Official Contact | 4784141946 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provision Counseling Center Llc 1776 N Jefferson St Ne Ste B Milledgeville GA 31061-2292 Ph: (478) 414-1946 | Provision Counseling Center Llc 1776 N Jefferson St Ne Ste B Milledgeville GA 31061-2292 Ph: (478) 414-1946 |
| NPI Number | 1174396725 |
|---|---|
| Provider Enumeration Date | 11/06/2023 |
| Last Update Date | 11/06/2023 |
| Certification Date | 11/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174396725 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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