Provider Demographics
NPI:1003546904
Name:DOUGLAS COUNSELING, COACHING, & CONSULTING, LLC
Entity Type:Organization
Organization Name:DOUGLAS COUNSELING, COACHING, & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT & OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TORRY
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-331-4654
Mailing Address - Street 1:2274 SALEM RD SE STE 106-1409
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2097
Mailing Address - Country:US
Mailing Address - Phone:470-331-4654
Mailing Address - Fax:
Practice Address - Street 1:1665 VILLAGE PLACE CIR NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-7109
Practice Address - Country:US
Practice Address - Phone:706-519-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1841683737OtherNPPES