Organization
CHANTAY GOLSON
Active
Other names
Purpose Community Therapeutic Services, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTAY GOLSON LPC (OWNER)
(770) 280-7288
Entity
Organization
Contact information
Practice address
1031 RAILROAD ST NW, SUITE B, CONYERS, GA 30012-5108
(770) 280-7288
(770) 983-6098
Mailing address
242 FAIRFIELD RD, VILLA RICA, GA 30180-3804
(770) 280-7288
(770) 983-6098
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003126621A
—
GA
Enumeration date
02/12/2013
Last updated
07/09/2013
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