Provider Demographics
NPI:1952606899
Name:MORNINGSTAR CHRISTIAN COUNSELING CENTER
Entity type:Organization
Organization Name:MORNINGSTAR CHRISTIAN COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PASTORAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:770-554-3110
Mailing Address - Street 1:7712 HAMPTON PL
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6770
Mailing Address - Country:US
Mailing Address - Phone:770-554-3110
Mailing Address - Fax:678-635-5354
Practice Address - Street 1:7712 HAMPTON PL
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6770
Practice Address - Country:US
Practice Address - Phone:770-554-3110
Practice Address - Fax:678-635-5354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL CONSERVATIVE CHRISTIAN CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10076 NCCA LICENSE251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health