Provider Demographics
NPI:1356734404
Name:GEORGIA AGAPE INC.
Entity type:Organization
Organization Name:GEORGIA AGAPE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COUNSELING
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:770-452-9995
Mailing Address - Street 1:3094 MERCER UNIVERSITY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4141
Mailing Address - Country:US
Mailing Address - Phone:770-452-9995
Mailing Address - Fax:770-457-3623
Practice Address - Street 1:3094 MERCER UNIVERSITY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4141
Practice Address - Country:US
Practice Address - Phone:770-452-9995
Practice Address - Fax:770-457-3623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty