Provider Demographics
NPI:1851712640
Name:RESTORATION COUNSELING OF ATLANTA, LLC
Entity Type:Organization
Organization Name:RESTORATION COUNSELING OF ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:STUCKERT
Authorized Official - Suffix:
Authorized Official - Credentials:MA MFT, LPC
Authorized Official - Phone:678-534-3824
Mailing Address - Street 1:102 MACY DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-6329
Mailing Address - Country:US
Mailing Address - Phone:678-534-3824
Mailing Address - Fax:678-281-1690
Practice Address - Street 1:595 COLONIAL PARK DR STE 102
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3760
Practice Address - Country:US
Practice Address - Phone:678-534-3824
Practice Address - Fax:678-281-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GALPC 004704305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No305S00000XManaged Care OrganizationsPoint of Service