Provider Demographics
NPI:1144578832
Name:ATLANTIC COUNSELING SERVICES
Entity Type:Organization
Organization Name:ATLANTIC COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:912-200-3195
Mailing Address - Street 1:132 STEPHENSON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5828
Mailing Address - Country:US
Mailing Address - Phone:912-200-3195
Mailing Address - Fax:912-349-7983
Practice Address - Street 1:132 STEPHENSON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5828
Practice Address - Country:US
Practice Address - Phone:912-200-3195
Practice Address - Fax:912-349-7983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty