Provider Demographics
NPI:1578195442
Name:PERSEVERANCE COUNSELING, LLC
Entity Type:Organization
Organization Name:PERSEVERANCE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONTERIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-994-3092
Mailing Address - Street 1:5701 MABLETON PKWY SW STE 202
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-3364
Mailing Address - Country:US
Mailing Address - Phone:678-994-3092
Mailing Address - Fax:866-473-0408
Practice Address - Street 1:5701 MABLETON PKWY SW STE 202
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3364
Practice Address - Country:US
Practice Address - Phone:678-994-3092
Practice Address - Fax:866-473-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1811342538Medicaid