Provider Demographics
NPI:1225628233
Name:ELEPHANT IN THE ROOM COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:ELEPHANT IN THE ROOM COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:SMOOT
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CPCS
Authorized Official - Phone:706-589-0660
Mailing Address - Street 1:2320 WRIGHTSBORO RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6233
Mailing Address - Country:US
Mailing Address - Phone:706-750-2809
Mailing Address - Fax:
Practice Address - Street 1:2320 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6233
Practice Address - Country:US
Practice Address - Phone:706-750-2809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty