Provider Demographics
NPI:1689042525
Name:GMG COUNSELING, LLC
Entity Type:Organization
Organization Name:GMG COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAGSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:706-248-3962
Mailing Address - Street 1:1838 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6611
Mailing Address - Country:US
Mailing Address - Phone:770-995-7622
Mailing Address - Fax:770-995-7854
Practice Address - Street 1:598 S MILLEDGE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1262
Practice Address - Country:US
Practice Address - Phone:706-353-0709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0050371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA102G703944Medicare PIN