Provider Demographics
NPI:1003072703
Name:PRACTICAL GUIDANCE & PSYCHTHERAPY INC.
Entity Type:Organization
Organization Name:PRACTICAL GUIDANCE & PSYCHTHERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-576-3824
Mailing Address - Street 1:747 LAUREN PKWY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3483
Mailing Address - Country:US
Mailing Address - Phone:678-576-3824
Mailing Address - Fax:
Practice Address - Street 1:747 LAUREN PKWY
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3483
Practice Address - Country:US
Practice Address - Phone:678-576-3824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003303LPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA205339263AMedicaid