Provider Demographics
NPI:1083124762
Name:GRACEOL COUNSELING CENTER INC
Entity Type:Organization
Organization Name:GRACEOL COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:YEMI
Authorized Official - Middle Name:JOKE
Authorized Official - Last Name:SOWEMIMO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:404-839-2688
Mailing Address - Street 1:1035 HONEY CREEK RD SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2948
Mailing Address - Country:US
Mailing Address - Phone:404-839-2688
Mailing Address - Fax:770-922-9498
Practice Address - Street 1:1035 HONEY CREEK RD SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2948
Practice Address - Country:US
Practice Address - Phone:404-839-2688
Practice Address - Fax:770-922-9498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN229849101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1790107381OtherNPI
1912016411OtherNPI
GA1639177066OtherNPI