Provider Demographics
NPI:1609639608
Name:PECULIAR ONE COUNSELING & CONSULTANT
Entity Type:Organization
Organization Name:PECULIAR ONE COUNSELING & CONSULTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-379-8450
Mailing Address - Street 1:118 STOCKBRIDGE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3627
Mailing Address - Country:US
Mailing Address - Phone:678-379-8450
Mailing Address - Fax:678-379-8450
Practice Address - Street 1:118 STOCKBRIDGE RD STE 104
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3627
Practice Address - Country:US
Practice Address - Phone:678-379-8450
Practice Address - Fax:678-379-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)