Provider Demographics
NPI:1225736317
Name:PRISMATIC COUNSELING OF GEORGIA, LLC
Entity Type:Organization
Organization Name:PRISMATIC COUNSELING OF GEORGIA, LLC
Other - Org Name:LEAH TAMAR, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:EPELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-286-1237
Mailing Address - Street 1:6175 HICKORY FLAT HWY STE 110-111
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-7207
Mailing Address - Country:US
Mailing Address - Phone:404-216-7000
Mailing Address - Fax:
Practice Address - Street 1:6175 HICKORY FLAT HWY STE 110-111
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-7207
Practice Address - Country:US
Practice Address - Phone:770-286-1237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC010655OtherGEORGIA SEC OF STATE LICENSING BOARD