Provider Demographics
NPI:1033579875
Name:COUNSELING INSTITUTE OF ATLANTA
Entity Type:Organization
Organization Name:COUNSELING INSTITUTE OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRETE-AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:404-630-1361
Mailing Address - Street 1:2788 LAKEWATER WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-5441
Mailing Address - Country:US
Mailing Address - Phone:404-630-1361
Mailing Address - Fax:770-441-9177
Practice Address - Street 1:5855 JIMMY CARTER BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2929
Practice Address - Country:US
Practice Address - Phone:404-630-1361
Practice Address - Fax:770-441-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-06
Last Update Date:2016-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5382101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty