Provider Demographics
NPI:1528366101
Name:SMALLS THERAPEUTIC COUNSELING CENTER
Entity Type:Organization
Organization Name:SMALLS THERAPEUTIC COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SMALLS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:404-328-6685
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-0071
Mailing Address - Country:US
Mailing Address - Phone:404-328-6685
Mailing Address - Fax:
Practice Address - Street 1:1195 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-1144
Practice Address - Country:US
Practice Address - Phone:404-328-6685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health