Provider Demographics
NPI:1134398357
Name:RISS COUNSELING, LLC
Entity type:Organization
Organization Name:RISS COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE REP.
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-410-0715
Mailing Address - Street 1:1655 CENTERVIEW DR APT 435
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-7693
Mailing Address - Country:US
Mailing Address - Phone:706-207-9151
Mailing Address - Fax:706-850-0899
Practice Address - Street 1:1 HUNTINGTON RD STE 205
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7206
Practice Address - Country:US
Practice Address - Phone:706-207-9151
Practice Address - Fax:706-850-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002955103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA140137175BMedicaid
GA140137175BMedicaid