Provider Demographics
NPI:1538705041
Name:CSJ PROFESSIONAL COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:CSJ PROFESSIONAL COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:SIMS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CCTP, CPCS
Authorized Official - Phone:770-653-2855
Mailing Address - Street 1:1429 CASTLEBROOKE WAY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4218
Mailing Address - Country:US
Mailing Address - Phone:678-488-8877
Mailing Address - Fax:
Practice Address - Street 1:707 WHITLOCK AVE SW STE H11
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3098
Practice Address - Country:US
Practice Address - Phone:770-653-2855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health