Provider Demographics
NPI:1841600871
Name:DIVERSIFIED COUNSELING & COUNSULTING
Entity Type:Organization
Organization Name:DIVERSIFIED COUNSELING & COUNSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOUVENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFORD-LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-851-5704
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:PINE LAKE
Mailing Address - State:GA
Mailing Address - Zip Code:30072-0614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:490 S STONE MTN LITHONIA RD
Practice Address - Street 2:88
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-1532
Practice Address - Country:US
Practice Address - Phone:404-662-2466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC003533251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health