Provider Demographics
NPI:1619500675
Name:JUSTIN TIME COUNSELING AND COACHING, LLC
Entity Type:Organization
Organization Name:JUSTIN TIME COUNSELING AND COACHING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROGDON-HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-325-2273
Mailing Address - Street 1:2886 SANDY PLAINS RD # 965082
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-9998
Mailing Address - Country:US
Mailing Address - Phone:770-325-2273
Mailing Address - Fax:
Practice Address - Street 1:120 S PARK SQ NE STE 203
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8631
Practice Address - Country:US
Practice Address - Phone:707-325-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty