Provider Demographics
NPI:1497081749
Name:ADVANCED COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCED COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEA
Authorized Official - Middle Name:J
Authorized Official - Last Name:OSENI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:678-585-9260
Mailing Address - Street 1:2820 LASSITER ROAD
Mailing Address - Street 2:SUITE A-150
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062
Mailing Address - Country:US
Mailing Address - Phone:678-585-9260
Mailing Address - Fax:678-585-9261
Practice Address - Street 1:2820 LASSITER ROAD
Practice Address - Street 2:SUITE A-150
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062
Practice Address - Country:US
Practice Address - Phone:678-585-9260
Practice Address - Fax:678-585-9261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004195101YP2500X
LAMFT637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA872292623AMedicaid