Provider Demographics
NPI:1831698869
Name:IN CONTROL COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:IN CONTROL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMETRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:470-632-0762
Mailing Address - Street 1:3895 MOUNTAIN VIEW RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-2388
Mailing Address - Country:US
Mailing Address - Phone:470-632-0762
Mailing Address - Fax:404-795-2055
Practice Address - Street 1:3895 MOUNTAIN VIEW RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-2388
Practice Address - Country:US
Practice Address - Phone:678-783-4075
Practice Address - Fax:404-795-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009735101YP2500X, 251S00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty