Provider Demographics
NPI:1760086854
Name:OBTAIN THE PROMISE SERVICES & CONSULTING LLC
Entity Type:Organization
Organization Name:OBTAIN THE PROMISE SERVICES & CONSULTING LLC
Other - Org Name:OBTAIN THE PROMISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:II
Authorized Official - Credentials:LPC
Authorized Official - Phone:704-968-7163
Mailing Address - Street 1:3205 WOODWARD CROSSING BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4944
Mailing Address - Country:US
Mailing Address - Phone:704-968-7163
Mailing Address - Fax:
Practice Address - Street 1:3205 WOODWARD CROSSING BLVD STE F
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4944
Practice Address - Country:US
Practice Address - Phone:470-326-7482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherIRS
GA003181398AMedicaid