Provider Demographics
NPI:1326036906
Name:CIRAKY, JAMES R (M A LPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:CIRAKY
Suffix:
Gender:M
Credentials:M A LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 663
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30142-0663
Mailing Address - Country:US
Mailing Address - Phone:404-293-5654
Mailing Address - Fax:
Practice Address - Street 1:113 MOUNTAIN BROOK DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-9057
Practice Address - Country:US
Practice Address - Phone:404-293-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1557101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10034882Medicaid