Provider Demographics
NPI:1720587579
Name:GROWTH AND GUIDANCE COUNSELING LLC
Entity Type:Organization
Organization Name:GROWTH AND GUIDANCE COUNSELING LLC
Other - Org Name:GROWTH AND GUIDANCE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:PORTIA
Authorized Official - Middle Name:ILEENE
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:470-939-3593
Mailing Address - Street 1:2995 OLD PEACHTREE RD APT 430
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-2285
Mailing Address - Country:US
Mailing Address - Phone:470-893-3593
Mailing Address - Fax:678-691-4366
Practice Address - Street 1:2995 OLD PEACHTREE RD APT 430
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2285
Practice Address - Country:US
Practice Address - Phone:470-893-3593
Practice Address - Fax:678-691-4366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty