Provider Demographics
NPI:1760927503
Name:ALPHARETTA/JOHNS CREEK COUNSELING FOR CHILDREN AND ADULTS
Entity Type:Organization
Organization Name:ALPHARETTA/JOHNS CREEK COUNSELING FOR CHILDREN AND ADULTS
Other - Org Name:JOHNS CREEK & ALPHARETTA COUNSELING FOR CHILDREN AND ADULTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:404-834-2363
Mailing Address - Street 1:400 PROSPECT PL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5468
Mailing Address - Country:US
Mailing Address - Phone:404-834-2363
Mailing Address - Fax:866-422-4042
Practice Address - Street 1:400 PROSPECT PL
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-5468
Practice Address - Country:US
Practice Address - Phone:404-834-2363
Practice Address - Fax:866-422-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YA0400X101YA0400X
GA101Y00000X101YM0800X
GA101YM0800X
GALPC008501101YP2500X
GAAMFT001278106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1548503428Medicaid