Provider Demographics
NPI:1164636296
Name:LASER COUNSELING SVCS LLC
Entity Type:Organization
Organization Name:LASER COUNSELING SVCS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:POPE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-271-9442
Mailing Address - Street 1:2070 BUFORD HWY
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:BURFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518
Mailing Address - Country:US
Mailing Address - Phone:770-271-9442
Mailing Address - Fax:770-271-8939
Practice Address - Street 1:2070 BUFORD HWY
Practice Address - Street 2:SUITE 2D
Practice Address - City:BURFORD
Practice Address - State:GA
Practice Address - Zip Code:30518
Practice Address - Country:US
Practice Address - Phone:770-271-9442
Practice Address - Fax:770-271-8939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty