Provider Demographics
NPI:1285732784
Name:ATHENS PASTORAL COUNSELING DBA SAMARITAN COUNSELING CENTER
Entity type:Organization
Organization Name:ATHENS PASTORAL COUNSELING DBA SAMARITAN COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV, MS
Authorized Official - Phone:706-369-7911
Mailing Address - Street 1:455 N LUMPKIN ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-2744
Mailing Address - Country:US
Mailing Address - Phone:706-369-7911
Mailing Address - Fax:706-208-9509
Practice Address - Street 1:455 N LUMPKIN ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2744
Practice Address - Country:US
Practice Address - Phone:706-369-7911
Practice Address - Fax:706-208-9509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty