Individual
CHARLES PHILLIP COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MAPC
Contact information
Practice address
2085 S MILLEDGE AVE STE 1, ATHENS, GA 30605-1655
(706) 206-3601
(706) 552-0756
Mailing address
2085 S MILLEDGE AVE STE 1, ATHENS, GA 30605-1655
(706) 206-3601
(706) 552-0756
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC007024
GA
Other
Enumeration date
09/25/2009
Last updated
11/01/2012
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