Jo-Anna Elizabeth Boutwell
Individual provider Active NPI Counselor · Vidalia, GA
NPI 1023902012 · NPPES record last updated Jun 5, 2025
Key facts
- NPI
- 1023902012
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- MFT002127 (GA)
- Practice address
- 204 Durden St
Vidalia, GA 30474-4608 - Phone
- (912) 253-6595
- NPI assigned
- Jun 5, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFT002127 | GA | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pineland Area Community Services Board | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | MFT002127 | GA | Yes |
Addresses
Primary practice location
204 Durden St
Vidalia, GA 30474-4608
Mailing address
204 Durden St
Vidalia, GA 30474-4608
Phone (912) 253-6595
Other providers in Vidalia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.