Provider Demographics
NPI:1639677636
Name:GREAT OAK COUNSELING
Entity Type:Organization
Organization Name:GREAT OAK COUNSELING
Other - Org Name:GREAT OAK COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:ROMANCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:248-506-3137
Mailing Address - Street 1:3050 ATLANTA RD SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8255
Mailing Address - Country:US
Mailing Address - Phone:248-506-3137
Mailing Address - Fax:
Practice Address - Street 1:3050 ATLANTA RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8255
Practice Address - Country:US
Practice Address - Phone:248-506-3137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0053361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty