Provider Demographics
NPI:1578317830
Name:WEST GEORGIA CHRISTIAN COUNSELING, LLC
Entity Type:Organization
Organization Name:WEST GEORGIA CHRISTIAN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC & CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:RALEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:608-609-4766
Mailing Address - Street 1:302 AUGUSTA WOODS DR
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-5224
Mailing Address - Country:US
Mailing Address - Phone:608-609-4766
Mailing Address - Fax:
Practice Address - Street 1:302 AUGUSTA WOODS DR
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-5224
Practice Address - Country:US
Practice Address - Phone:608-609-4766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health