Organization
OLIVIA EGAN COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLIVIA EGAN LPC (SOLE MEMBER)
(678) 837-5465
Entity
Organization
Contact information
Practice address
311 MOBLEY DR, STATESBORO, GA 30458-9162
(678) 837-5465
Mailing address
311 MOBLEY DR, STATESBORO, GA 30458-9162
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
LPC007842
GA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
LPC007842
GA
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
LPC007842
GA
Other
Enumeration date
08/23/2017
Last updated
08/23/2017
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