Provider Demographics
NPI:1063852051
Name:SYNERGY COUNSELING SERVICES
Entity Type:Organization
Organization Name:SYNERGY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYRTHIL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, NCSC
Authorized Official - Phone:678-697-7018
Mailing Address - Street 1:1400 VETERANS MEMORIAL HWY SE
Mailing Address - Street 2:SUITE 134-179
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2945
Mailing Address - Country:US
Mailing Address - Phone:678-697-7018
Mailing Address - Fax:678-999-3157
Practice Address - Street 1:1827 POWERS FERRY RD SE
Practice Address - Street 2:BLDG. 21, STE 350
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5621
Practice Address - Country:US
Practice Address - Phone:678-697-7018
Practice Address - Fax:678-999-3157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004380251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health