Provider Demographics
NPI:1770234650
Name:COUNSELING CENTER AT DULUTH LLC
Entity Type:Organization
Organization Name:COUNSELING CENTER AT DULUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHELALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-285-4035
Mailing Address - Street 1:PO BOX 27090
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-6790
Mailing Address - Country:US
Mailing Address - Phone:470-704-5010
Mailing Address - Fax:470-704-5101
Practice Address - Street 1:4191 PLEASANT HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1411
Practice Address - Country:US
Practice Address - Phone:470-704-5010
Practice Address - Fax:470-704-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder