Betty Kathleen Demine, LPC
Individual provider Active NPI Counselor · Zebulon, GA
NPI 1366084576 · NPPES record last updated Sep 18, 2024
Key facts
- NPI
- 1366084576
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 420 Thomaston St
Zebulon, GA 30295-3387 - Phone
- (404) 960-1282
- Fax
- (855) 817-2428
- NPI assigned
- Oct 9, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240502002229 | GA | Practitioner - Mental Health Counselor | 9133569551 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007579 | GA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Discovery Counseling and Assessment Center, LLC | Current |
Accepting new patients | |
| Pathways Center for Behavioral and Developmental Growth | Current |
Accepting new patients | |
| Pathways Center for Behavioral and Developmental Growth | Current |
Accepting new patients | |
| Pathways Center for Behavioral & Developmental Growth | Past |
Accepting new patients |
Locations
756 Woodbury Hwy
Greenville, GA 30222
Phone (706) 672-1118
122 Gordon Commercial Dr
Ste C
Lagrange, GA 30240
Phone (678) 854-2150
4006 Highway 34 E
Sharpsburg, GA 30277
Phone (404) 844-6868
420 Thomaston St
Zebulon, GA 30295
Phone (404) 960-1282
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 007579 | GA | |
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
420 Thomaston St
Zebulon, GA 30295-3387
Mailing address
756 Woodbury Hwy
Greenville, GA 30222-1514
Phone (706) 672-1118
Other providers in Zebulon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2024. 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.