Provider Demographics
NPI:1225289648
Name:CADILLAC COMPREHENSIVE COUNSELING SERVICES
Entity Type:Organization
Organization Name:CADILLAC COMPREHENSIVE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CEE CEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-334-5017
Mailing Address - Street 1:3150 SHOAL CREEK CT
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-2426
Mailing Address - Country:US
Mailing Address - Phone:678-334-5017
Mailing Address - Fax:
Practice Address - Street 1:3150 SHOAL CREEK CT
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-2426
Practice Address - Country:US
Practice Address - Phone:678-334-5017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service