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Organization
EVERLASTING PEACE COUNSELING AND SUPPORT SERVICES
Active
Organization
EVERLASTING PEACE COUNSELING AND SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD DUBOSE LPC (OWNER /PRESIDENT)
(706) 464-8539
Entity
Organization
Contact information
Practice address
2210 WYNNTON RD STE 206, COLUMBUS, GA 31906-5820
(706) 464-4597
Mailing address
PO BOX 12225, COLUMBUS, GA 31917-2225
(706) 464-8539
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004843
GEORGIA LICENSE NUMBER
GA
01
—
2924
ALABAMA LICENSE NUMBER
AL
Enumeration date
09/11/2018
Last updated
09/11/2018
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