Provider Demographics
NPI:1750653309
Name:EZER COUNSELING, LLC
Entity Type:Organization
Organization Name:EZER COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-540-7681
Mailing Address - Street 1:5300 MEMORIAL DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3148
Mailing Address - Country:US
Mailing Address - Phone:770-540-7681
Mailing Address - Fax:678-298-8321
Practice Address - Street 1:5300 MEMORIAL DR
Practice Address - Street 2:SUITE 115
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3148
Practice Address - Country:US
Practice Address - Phone:770-540-7681
Practice Address - Fax:678-298-8321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-28
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2159101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty