Provider Demographics
NPI:1972871580
Name:TORELL, CRAIG (MA, MDIV, LPC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:TORELL
Suffix:
Gender:M
Credentials:MA, MDIV, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2767 STILL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-1182
Mailing Address - Country:US
Mailing Address - Phone:770-218-9005
Mailing Address - Fax:770-485-8481
Practice Address - Street 1:2985 CHEROKEE ST NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2863
Practice Address - Country:US
Practice Address - Phone:770-218-9005
Practice Address - Fax:770-485-8481
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007512101YP2500X
GAAPC002371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional