Provider Demographics
NPI:1801536438
Name:MMKG COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:MMKG COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLO
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-712-5020
Mailing Address - Street 1:1950 BARRETT LAKES BLVD NW APT 1226
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7535
Mailing Address - Country:US
Mailing Address - Phone:770-712-5020
Mailing Address - Fax:
Practice Address - Street 1:1275 SHILOH RD NW STE 3030
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7186
Practice Address - Country:US
Practice Address - Phone:770-712-5020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health