Provider Demographics
NPI:1710239546
Name:GEORGIA COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:GEORGIA COUNSELING CENTER, INC.
Other - Org Name:GEORGIA COUNSELING CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-231-2031
Mailing Address - Street 1:250 CHURCHILL CT
Mailing Address - Street 2:SUITE 700
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6331
Mailing Address - Country:US
Mailing Address - Phone:678-231-2031
Mailing Address - Fax:866-264-2548
Practice Address - Street 1:250 CHURCHILL CT
Practice Address - Street 2:SUITE 700
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6331
Practice Address - Country:US
Practice Address - Phone:678-231-2031
Practice Address - Fax:866-264-2548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004155101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA092650842AMedicaid