Provider Demographics
NPI:1578827606
Name:THE PROGRESSIVE COUNSELING AND THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:THE PROGRESSIVE COUNSELING AND THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:SR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-592-9454
Mailing Address - Street 1:101 DEVANT ST
Mailing Address - Street 2:SUITE 606
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2710
Mailing Address - Country:US
Mailing Address - Phone:678-592-9454
Mailing Address - Fax:
Practice Address - Street 1:101 DEVANT ST
Practice Address - Street 2:SUITE 606
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2710
Practice Address - Country:US
Practice Address - Phone:678-592-9454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-04
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004685251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health