Provider Demographics
NPI:1295062990
Name:COUNSELING ASSOCIATES OF NORTHWEST GEORGIA INC
Entity type:Organization
Organization Name:COUNSELING ASSOCIATES OF NORTHWEST GEORGIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CLEELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:706-291-9522
Mailing Address - Street 1:101 E 2ND AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3177
Mailing Address - Country:US
Mailing Address - Phone:706-291-9522
Mailing Address - Fax:
Practice Address - Street 1:101 E 2ND AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3177
Practice Address - Country:US
Practice Address - Phone:706-291-9522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty