Provider Demographics
NPI:1023489952
Name:INNER COACH COUNSELING
Entity type:Organization
Organization Name:INNER COACH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LCSW,CHT
Authorized Official - Phone:404-333-2439
Mailing Address - Street 1:2751 BUFORD HWY NE
Mailing Address - Street 2:STE 700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3207
Mailing Address - Country:US
Mailing Address - Phone:404-333-2439
Mailing Address - Fax:
Practice Address - Street 1:2751 BUFORD HWY NE
Practice Address - Street 2:STE 700
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3207
Practice Address - Country:US
Practice Address - Phone:404-333-2439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0054671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty