Provider Demographics
NPI:1689347304
Name:MEDALLION COUNSELING AND CONSULTING
Entity Type:Organization
Organization Name:MEDALLION COUNSELING AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-509-5794
Mailing Address - Street 1:1332 MULBERRY BOULEVARD
Mailing Address - Street 2:APT. 20-205
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407
Mailing Address - Country:US
Mailing Address - Phone:404-509-5794
Mailing Address - Fax:
Practice Address - Street 1:1332 MULBERRY BOULEVARD
Practice Address - Street 2:APT. 20-205
Practice Address - City:PORT WENTWORTH
Practice Address - State:GA
Practice Address - Zip Code:31407
Practice Address - Country:US
Practice Address - Phone:404-509-5794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty