Provider Demographics
NPI:1851842553
Name:GROW DEEP COUNSELING, LLC
Entity Type:Organization
Organization Name:GROW DEEP COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, CPCS
Authorized Official - Phone:770-331-9988
Mailing Address - Street 1:PO BOX 491172
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049-0020
Mailing Address - Country:US
Mailing Address - Phone:770-331-9988
Mailing Address - Fax:770-492-0301
Practice Address - Street 1:4830 RIVER GREEN PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-2505
Practice Address - Country:US
Practice Address - Phone:770-331-9988
Practice Address - Fax:770-492-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003658101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty