Provider Demographics
NPI:1518109990
Name:INTEGRATED COUNSELING AND CONSULTING SERVICES LLC
Entity Type:Organization
Organization Name:INTEGRATED COUNSELING AND CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-769-8771
Mailing Address - Street 1:909 EAGLES LANDING PKWY
Mailing Address - Street 2:SUITE 400 - #136
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7247
Mailing Address - Country:US
Mailing Address - Phone:404-769-8771
Mailing Address - Fax:
Practice Address - Street 1:909 EAGLES LANDING PKWY
Practice Address - Street 2:SUITE 400 - #136
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7247
Practice Address - Country:US
Practice Address - Phone:404-769-8771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health