Provider Demographics
NPI:1568532166
Name:ADVANTAGE COUNSELING SERVICE, INC
Entity Type:Organization
Organization Name:ADVANTAGE COUNSELING SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-471-0033
Mailing Address - Street 1:2180 SATELLITE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4927
Mailing Address - Country:US
Mailing Address - Phone:770-471-0033
Mailing Address - Fax:770-471-4639
Practice Address - Street 1:2180 SATELLITE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4927
Practice Address - Country:US
Practice Address - Phone:770-471-0033
Practice Address - Fax:770-471-4639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA327206642AMedicaid