Provider Demographics
NPI:1518187715
Name:WEST COBB COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:WEST COBB COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAGGARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-435-2931
Mailing Address - Street 1:4015 SOUTH COBB DR SE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6315
Mailing Address - Country:US
Mailing Address - Phone:770-435-2931
Mailing Address - Fax:770-435-2942
Practice Address - Street 1:4015 SOUTH COBB DR SE
Practice Address - Street 2:SUITE 4
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6315
Practice Address - Country:US
Practice Address - Phone:770-435-2931
Practice Address - Fax:770-435-2942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0014561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty