Provider Demographics
NPI:1194063198
Name:OASIS COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:OASIS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC
Authorized Official - Phone:706-543-3522
Mailing Address - Street 1:1720 LEXINGTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-2330
Mailing Address - Country:US
Mailing Address - Phone:706-543-3522
Mailing Address - Fax:706-543-3523
Practice Address - Street 1:1720 LEXINGTON RD STE A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-2330
Practice Address - Country:US
Practice Address - Phone:706-543-3522
Practice Address - Fax:706-543-3523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129600AMedicaid