Provider Demographics
NPI:1801193081
Name:GEORGIAN COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:GEORGIAN COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PROFESSIONAL COUNSEL
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MEZZA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-978-0464
Mailing Address - Street 1:44 DARBYS CROSSING DR
Mailing Address - Street 2:SUITE 200C
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-6008
Mailing Address - Country:US
Mailing Address - Phone:678-978-0464
Mailing Address - Fax:678-715-8796
Practice Address - Street 1:44 DARBYS CROSSING DR
Practice Address - Street 2:SUITE 200C
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-6008
Practice Address - Country:US
Practice Address - Phone:678-978-0464
Practice Address - Fax:678-715-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 4731251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health