| Southeast Georgia Counseling & Play Therapy, Llc | |
|
140 Lakes Blvd Kingsland GA 31548-6813 | |
| (912) 510-6250 | |
| (912) 510-6960 |
| Full Name | Southeast Georgia Counseling & Play Therapy, Llc |
|---|---|
| Speciality | Counselor |
| Location | 140 Lakes Blvd, Kingsland, Georgia |
| Authorized Official Name and Position | Lindsay Bottoms (OWNER) |
| Authorized Official Contact | 9125106250 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Georgia Counseling & Play Therapy, Llc 147 Serenity Farms Rd Woodbine GA 31569-4447 Ph: (912) 510-6250 | Southeast Georgia Counseling & Play Therapy, Llc 140 Lakes Blvd Kingsland GA 31548-6813 Ph: (912) 510-6250 |
| NPI Number | 1902576119 |
|---|---|
| Provider Enumeration Date | 09/18/2021 |
| Last Update Date | 09/18/2021 |
| Certification Date | 09/18/2021 |
| Medicare PECOS PAC ID | 7810429115 |
|---|---|
| Medicare Enrollment ID | O20241011000054 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902576119 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Lindsay Bottoms |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104388917 PECOS PAC ID: 8729510029 Enrollment ID: I20241011000071 |
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