Provider Demographics
NPI:1467943290
Name:MARIETTA COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:MARIETTA COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:770-429-9257
Mailing Address - Street 1:17 AVIATION RD SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2411
Mailing Address - Country:US
Mailing Address - Phone:770-429-9257
Mailing Address - Fax:877-656-2843
Practice Address - Street 1:17 AVIATION RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2411
Practice Address - Country:US
Practice Address - Phone:770-429-9257
Practice Address - Fax:877-656-2843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty