Provider Demographics
NPI:1760865877
Name:DR. RICHARD J. CARELL P.C.
Entity Type:Organization
Organization Name:DR. RICHARD J. CARELL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CARELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-551-8152
Mailing Address - Street 1:1200 ABERNATHY RD
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5662
Mailing Address - Country:US
Mailing Address - Phone:770-551-8152
Mailing Address - Fax:
Practice Address - Street 1:1200 ABERNATHY RD
Practice Address - Street 2:SUITE 1700
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5662
Practice Address - Country:US
Practice Address - Phone:770-551-8152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008424261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)