Provider Demographics
NPI:1063850402
Name:RIVERSTONE COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:RIVERSTONE COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:FEDERICO
Authorized Official - Suffix:
Authorized Official - Credentials:MA NCC LPC
Authorized Official - Phone:770-213-3615
Mailing Address - Street 1:132 RIVERSTONE TER
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-1703
Mailing Address - Country:US
Mailing Address - Phone:770-213-3615
Mailing Address - Fax:678-880-9813
Practice Address - Street 1:132 RIVERSTONE TER
Practice Address - Street 2:SUITE 102
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-1703
Practice Address - Country:US
Practice Address - Phone:770-213-3615
Practice Address - Fax:678-880-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007159251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health