Provider Demographics
NPI:1134869647
Name:SAM MARION COUNSELING AND CONSULTING, INC
Entity type:Organization
Organization Name:SAM MARION COUNSELING AND CONSULTING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARION
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-904-1761
Mailing Address - Street 1:115 E MAIN ST STE A1B-8L
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5727
Mailing Address - Country:US
Mailing Address - Phone:770-904-1761
Mailing Address - Fax:
Practice Address - Street 1:4482 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-7512
Practice Address - Country:US
Practice Address - Phone:770-904-1761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty