Provider Demographics
NPI:1558528828
Name:MARIETTA WEST COBB COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:MARIETTA WEST COBB COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-591-7518
Mailing Address - Street 1:707 WHITLOCK AVE SW
Mailing Address - Street 2:SUITE H-10
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3000
Mailing Address - Country:US
Mailing Address - Phone:770-591-7518
Mailing Address - Fax:678-498-2843
Practice Address - Street 1:707 WHITLOCK AVE SW STE H10
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:770-415-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA129577652AMedicaid
GA5732533OtherAETNA
GA726881000OtherMAGELLAN
GA1427124593OtherBCBS
GA10063297OtherAMERIGROUP
GA10063295OtherAMERIGROUP
GA=========OtherHUMANA