Provider Demographics
| NPI: | 1093323305 |
|---|---|
| Name: | REFINERY COUNSELING SERVICES LLC |
| Entity Type: | Organization |
| Organization Name: | REFINERY COUNSELING SERVICES LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | QIANA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | TOY-ELLIS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 706-987-3315 |
| Mailing Address - Street 1: | 4570 REESE RD STE B |
| Mailing Address - Street 2: | |
| Mailing Address - City: | COLUMBUS |
| Mailing Address - State: | GA |
| Mailing Address - Zip Code: | 31907-1177 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 706-987-3315 |
| Mailing Address - Fax: | 229-207-2972 |
| Practice Address - Street 1: | 4570 REESE RD STE B |
| Practice Address - Street 2: | |
| Practice Address - City: | COLUMBUS |
| Practice Address - State: | GA |
| Practice Address - Zip Code: | 31907-1177 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 706-987-3315 |
| Practice Address - Fax: | 229-207-2972 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2020-07-22 |
| Last Update Date: | 2021-09-13 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | ||
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 252Y00000X | Agencies | Early Intervention Provider Agency | ||
| No | 253Z00000X | Agencies | In Home Supportive Care | ||
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| GA | 003230343A | Medicaid | |
| GA | 003230323A | Medicaid |
