Provider Demographics
NPI:1235880550
Name:TRINITY RISING COUNSELING CENTER
Entity Type:Organization
Organization Name:TRINITY RISING COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELING
Authorized Official - Prefix:
Authorized Official - First Name:TAMMARRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LETBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:M ED LPC
Authorized Official - Phone:469-407-1120
Mailing Address - Street 1:545 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1328
Mailing Address - Country:US
Mailing Address - Phone:469-407-1120
Mailing Address - Fax:678-519-2888
Practice Address - Street 1:545 FORREST AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1328
Practice Address - Country:US
Practice Address - Phone:469-407-1120
Practice Address - Fax:678-519-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX394212001Medicaid