Provider Demographics
NPI:1619689742
Name:ATLANTA CHRISTIAN COUNSELING LLC
Entity Type:Organization
Organization Name:ATLANTA CHRISTIAN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARLENA
Authorized Official - Middle Name:JANETTE
Authorized Official - Last Name:PIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:681-242-7651
Mailing Address - Street 1:112 BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-5703
Mailing Address - Country:US
Mailing Address - Phone:681-242-7651
Mailing Address - Fax:
Practice Address - Street 1:15 FISH CAMP ROAD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240
Practice Address - Country:US
Practice Address - Phone:681-242-7651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty