Provider Demographics
NPI:1093955205
Name:EAGLE'S LANDING CHRISTIAN COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:EAGLE'S LANDING CHRISTIAN COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:DENICE
Authorized Official - Last Name:COLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-289-6981
Mailing Address - Street 1:1944 BRANNAN RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4310
Mailing Address - Country:US
Mailing Address - Phone:678-289-6981
Mailing Address - Fax:770-898-0366
Practice Address - Street 1:1944 BRANNAN RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4310
Practice Address - Country:US
Practice Address - Phone:678-289-6981
Practice Address - Fax:678-289-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3717101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty