Provider Demographics
NPI:1790222024
Name:INNERVISIONS COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:INNERVISIONS COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-851-4641
Mailing Address - Street 1:524 OAKSIDE PL
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-8811
Mailing Address - Country:US
Mailing Address - Phone:770-851-4641
Mailing Address - Fax:
Practice Address - Street 1:1275 SHILOH RD NW
Practice Address - Street 2:SUITE 3030
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7175
Practice Address - Country:US
Practice Address - Phone:678-956-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007627251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health