Provider Demographics
NPI:1821478009
Name:GEORGIA COUNSELING CENTER INC
Entity Type:Organization
Organization Name:GEORGIA COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:648-231-2031
Mailing Address - Street 1:335 PARKWAY 575 STE 301
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6433
Mailing Address - Country:US
Mailing Address - Phone:648-231-2031
Mailing Address - Fax:866-264-2548
Practice Address - Street 1:335 PARKWAY 575 STE 301
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6433
Practice Address - Country:US
Practice Address - Phone:648-231-2031
Practice Address - Fax:866-264-2548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007620101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty