Provider Demographics
NPI:1114395563
Name:CAPSTONE COUNSELING LLC
Entity Type:Organization
Organization Name:CAPSTONE COUNSELING LLC
Other - Org Name:CAPSTONE CENTER FOR COUNSELING DBT AND RELATIONAL TRAUMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REVA
Authorized Official - Middle Name:MANON
Authorized Official - Last Name:KRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-727-8126
Mailing Address - Street 1:9 DUNWOODY PARK
Mailing Address - Street 2:SUITE 136
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7407
Mailing Address - Country:US
Mailing Address - Phone:770-744-5055
Mailing Address - Fax:470-545-4382
Practice Address - Street 1:9 DUNWOODY PARK
Practice Address - Street 2:SUITE 136
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-7407
Practice Address - Country:US
Practice Address - Phone:770-744-5055
Practice Address - Fax:470-545-4382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0044871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003151158BMedicaid