Provider Demographics
NPI:1770879314
Name:WEST COBB MARRIAGE & FAMILY COUNSELING, INC.
Entity type:Organization
Organization Name:WEST COBB MARRIAGE & FAMILY COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:POFF-LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LMFT, LPC
Authorized Official - Phone:404-266-3535
Mailing Address - Street 1:2645 DALLAS HWY SW
Mailing Address - Street 2:STE. 210
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-7577
Mailing Address - Country:US
Mailing Address - Phone:404-266-3535
Mailing Address - Fax:770-872-0525
Practice Address - Street 1:2645 DALLAS HWY SW
Practice Address - Street 2:STE. 210
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-7577
Practice Address - Country:US
Practice Address - Phone:404-266-3535
Practice Address - Fax:770-872-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000918101YP2500X
GA000339106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty