Provider Demographics
NPI:1366019994
Name:COOL PROGRAM COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:COOL PROGRAM COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-964-2818
Mailing Address - Street 1:1115 MOUNT ZION RD STE 18B
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2275
Mailing Address - Country:US
Mailing Address - Phone:404-964-2818
Mailing Address - Fax:678-868-9433
Practice Address - Street 1:1115 MOUNT ZION RD STE 18B
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2275
Practice Address - Country:US
Practice Address - Phone:404-964-2818
Practice Address - Fax:678-868-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)