Provider Demographics
NPI:1922673052
Name:REDWOOD COUNSELING LLC
Entity Type:Organization
Organization Name:REDWOOD COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LPC,NCC
Authorized Official - Phone:678-371-4803
Mailing Address - Street 1:805 GLYNN ST S
Mailing Address - Street 2:STE 127#326
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2077
Mailing Address - Country:US
Mailing Address - Phone:678-371-4803
Mailing Address - Fax:678-723-0936
Practice Address - Street 1:220 WERNER WAY
Practice Address - Street 2:
Practice Address - City:SENOIA
Practice Address - State:GA
Practice Address - Zip Code:30276-3615
Practice Address - Country:US
Practice Address - Phone:678-371-4803
Practice Address - Fax:678-723-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1649577529OtherU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES