Provider Demographics
NPI:1437408127
Name:CROSBY MITCHELL COUNSELING SERVICES LLP
Entity Type:Organization
Organization Name:CROSBY MITCHELL COUNSELING SERVICES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:OREM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-233-2809
Mailing Address - Street 1:315 W SOLOMON ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-3038
Mailing Address - Country:US
Mailing Address - Phone:770-233-2809
Mailing Address - Fax:770-233-2810
Practice Address - Street 1:315 W SOLOMON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-3038
Practice Address - Country:US
Practice Address - Phone:770-233-2809
Practice Address - Fax:770-233-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0406101YA0400X
GAAPC002290101YP2500X
GALPC001607101YP2500X
GAMFT001185106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty