Provider Demographics
NPI:1982061545
Name:SWCCOUNSELING
Entity Type:Organization
Organization Name:SWCCOUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-469-0124
Mailing Address - Street 1:4886 CANDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-1606
Mailing Address - Country:US
Mailing Address - Phone:770-469-0124
Mailing Address - Fax:
Practice Address - Street 1:814 MIMOSA BLVD
Practice Address - Street 2:BLDG C
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4410
Practice Address - Country:US
Practice Address - Phone:678-680-8731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008645273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit