Provider Demographics
NPI:1093857419
Name:DALLAS FAMILY COUNSELING CENTER
Entity Type:Organization
Organization Name:DALLAS FAMILY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-445-6358
Mailing Address - Street 1:110 EVANS MILL DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-1622
Mailing Address - Country:US
Mailing Address - Phone:770-445-6358
Mailing Address - Fax:770-445-7262
Practice Address - Street 1:110 EVANS MILL DR
Practice Address - Street 2:SUITE 305
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-1622
Practice Address - Country:US
Practice Address - Phone:770-445-6358
Practice Address - Fax:770-445-7262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA888106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty