Provider Demographics
NPI:1093160517
Name:LEA COUNSELING, LLC
Entity Type:Organization
Organization Name:LEA COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-339-7667
Mailing Address - Street 1:600 PEACHTREE PKWY
Mailing Address - Street 2:STE 112
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7461
Mailing Address - Country:US
Mailing Address - Phone:678-525-7818
Mailing Address - Fax:770-995-1959
Practice Address - Street 1:600 PEACHTREE PKWY
Practice Address - Street 2:STE 112
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7461
Practice Address - Country:US
Practice Address - Phone:678-525-7818
Practice Address - Fax:770-995-1959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0043961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty