Provider Demographics
NPI:1285993402
Name:STONEGATE COUNSELING ASSOCIATES, PC
Entity type:Organization
Organization Name:STONEGATE COUNSELING ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:BUCHA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-546-7550
Mailing Address - Street 1:650 OGLETHORPE AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2216
Mailing Address - Country:US
Mailing Address - Phone:706-546-7550
Mailing Address - Fax:
Practice Address - Street 1:650 OGLETHORPE AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2216
Practice Address - Country:US
Practice Address - Phone:706-546-7550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006441101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty