Provider Demographics
NPI:1356533079
Name:SEDONA COUNSELING, INC
Entity type:Organization
Organization Name:SEDONA COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:678-817-6600
Mailing Address - Street 1:500 W LANIER AVE
Mailing Address - Street 2:SSUITE 508
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7636
Mailing Address - Country:US
Mailing Address - Phone:678-817-6600
Mailing Address - Fax:678-817-6333
Practice Address - Street 1:500 W LANIER AVE
Practice Address - Street 2:SUITE 508
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7636
Practice Address - Country:US
Practice Address - Phone:678-817-6600
Practice Address - Fax:678-817-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1399101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty