Provider Demographics
NPI:1396015715
Name:TRINITY COUNSELING CENTER
Entity Type:Organization
Organization Name:TRINITY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-575-4997
Mailing Address - Street 1:105 N CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4154
Mailing Address - Country:US
Mailing Address - Phone:678-575-4997
Mailing Address - Fax:678-818-4619
Practice Address - Street 1:612 MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-1149
Practice Address - Country:US
Practice Address - Phone:678-575-4997
Practice Address - Fax:678-818-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003292101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003108526AMedicaid