Provider Demographics
NPI:1811233711
Name:POSITIVE DIRECTION COUNSELING CENTER
Entity Type:Organization
Organization Name:POSITIVE DIRECTION COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ICADC
Authorized Official - Phone:770-318-3727
Mailing Address - Street 1:175 LAKESHORE CIR SE
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-3237
Mailing Address - Country:US
Mailing Address - Phone:770-318-3727
Mailing Address - Fax:770-485-9228
Practice Address - Street 1:175 LAKESHORE CIR SE
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-3237
Practice Address - Country:US
Practice Address - Phone:770-318-3727
Practice Address - Fax:770-485-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001563101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty