Provider Demographics
NPI:1649403015
Name:WELLSPRING COUNSELING CENTER
Entity Type:Organization
Organization Name:WELLSPRING COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:QUERY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-587-4736
Mailing Address - Street 1:700 OLD ROSWELL LAKES PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:770-587-4736
Mailing Address - Fax:678-802-2116
Practice Address - Street 1:700 OLD ROSWELL LAKES PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:770-587-4736
Practice Address - Fax:678-802-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty