Provider Demographics
NPI:1972830263
Name:PARACLETE CHRISTIAN COUNSELING AND EDUCATIONAL SERVICES
Entity Type:Organization
Organization Name:PARACLETE CHRISTIAN COUNSELING AND EDUCATIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:770-599-1102
Mailing Address - Street 1:252 SEAVY ST
Mailing Address - Street 2:P.O. BOX 147
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-1806
Mailing Address - Country:US
Mailing Address - Phone:770-599-1102
Mailing Address - Fax:770-599-0806
Practice Address - Street 1:252 SEAVY ST
Practice Address - Street 2:
Practice Address - City:SENOIA
Practice Address - State:GA
Practice Address - Zip Code:30276-1806
Practice Address - Country:US
Practice Address - Phone:770-599-1102
Practice Address - Fax:770-599-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001386251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA237506833AMedicaid