Provider Demographics
NPI:1740600287
Name:SUPPORTIVE COUNSELING & CONSULTING, LLC
Entity type:Organization
Organization Name:SUPPORTIVE COUNSELING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR/OWN
Authorized Official - Prefix:
Authorized Official - First Name:NINESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONT-REYNAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:678-834-0880
Mailing Address - Street 1:3455 N DESERT DR
Mailing Address - Street 2:BLDG 3 SUITE 101
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5725
Mailing Address - Country:US
Mailing Address - Phone:678-834-0880
Mailing Address - Fax:678-834-0880
Practice Address - Street 1:3455 N DESERT DR
Practice Address - Street 2:BLDG 3 SUITE 101
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5725
Practice Address - Country:US
Practice Address - Phone:678-834-0880
Practice Address - Fax:678-834-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006283101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty