Provider Demographics
NPI:1023405271
Name:JOURNEY COUNSELING AND PSYHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:JOURNEY COUNSELING AND PSYHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CERJAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:229-255-3099
Mailing Address - Street 1:2339 LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3131
Mailing Address - Country:US
Mailing Address - Phone:229-255-3099
Mailing Address - Fax:229-638-6302
Practice Address - Street 1:2339 LAKE PARK DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3131
Practice Address - Country:US
Practice Address - Phone:229-255-3099
Practice Address - Fax:229-638-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002049103TC0700X
GALPC006319101YP2500X
235Z00000X
GALPC007520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126707BMedicaid
GA000733961AMedicaid
GA003108087BMedicaid
GA003140236AMedicaid