Provider Demographics
NPI:1093426124
Name:AUTHENTIC SPIRIT COUNSELING SERVICES
Entity Type:Organization
Organization Name:AUTHENTIC SPIRIT COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANI
Authorized Official - Middle Name:
Authorized Official - Last Name:FRYAR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-890-6127
Mailing Address - Street 1:297 NEW CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30185-2803
Mailing Address - Country:US
Mailing Address - Phone:678-890-6127
Mailing Address - Fax:
Practice Address - Street 1:206 BANKHEAD HWY
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3455
Practice Address - Country:US
Practice Address - Phone:678-890-6127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty