Samuel Clark Cutler IV, LPC
Individual provider Active NPI Professional Counselor · Bogart, GA
NPI 1104600253 · NPPES record last updated Aug 21, 2023
Key facts
- NPI
- 1104600253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC011624 (GA)
- Practice address
- 1621 Oconee Crossing Cir
Bogart, GA 30622-4583 - Phone
- (706) 338-2988
- NPI assigned
- Aug 21, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC011624 | GA | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC011624 | GA | Yes |
Addresses
Primary practice location
1621 Oconee Crossing Cir
Bogart, GA 30622-4583
Mailing address
1621 Oconee Crossing Cir
Bogart, GA 30622-4583
Other providers in Bogart, GA
- Nickie Cole
- Tamara Collins
- Catherine Colquitt
- Creative Hospice Care Inc
- Creative Hospice Care, Inc
- Saron Daniel
- Tamika Darden
- Deneshia Davenport
- Debra Alvis, PH.D., Inc
- William Alexander Dix
All providers in Bogart, GA · Professional Counselor in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.