Provider Demographics
NPI:1215623442
Name:MASTERPIECES COUNSELING AND THERAPY LLC
Entity type:Organization
Organization Name:MASTERPIECES COUNSELING AND THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY JAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-262-7198
Mailing Address - Street 1:1736 W GORDON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-3017
Mailing Address - Country:US
Mailing Address - Phone:229-262-7198
Mailing Address - Fax:
Practice Address - Street 1:1736 W GORDON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-3017
Practice Address - Country:US
Practice Address - Phone:229-262-7198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty