Provider Demographics
NPI:1396484812
Name:NORTH FULTON COUNSELING PSYCHOTHERAPY AND CONSULTING
Entity type:Organization
Organization Name:NORTH FULTON COUNSELING PSYCHOTHERAPY AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:678-469-1296
Mailing Address - Street 1:3211 CANYON POINT CIR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5109
Mailing Address - Country:US
Mailing Address - Phone:678-469-1296
Mailing Address - Fax:404-365-3859
Practice Address - Street 1:11285 EKINS ROAD SUITE
Practice Address - Street 2:SUITE D-2
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3007
Practice Address - Country:US
Practice Address - Phone:855-772-8884
Practice Address - Fax:404-365-3859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1205106085OtherNON MEDICAID PROVIDER
GA1821478264OtherNON MEDICARE MENTAL HEALTH PROVIDER