Provider Demographics
NPI:1982940425
Name:COUNSELING FOR GROWTH AND ENRICHMENT, LLC
Entity Type:Organization
Organization Name:COUNSELING FOR GROWTH AND ENRICHMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIRGIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, RPT&S, CLYL
Authorized Official - Phone:706-235-6990
Mailing Address - Street 1:5 SAINT ANDREWS WAY SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-8484
Mailing Address - Country:US
Mailing Address - Phone:706-292-0587
Mailing Address - Fax:706-292-9437
Practice Address - Street 1:104 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3128
Practice Address - Country:US
Practice Address - Phone:706-235-6990
Practice Address - Fax:706-235-4985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003389251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTRICARE MENTAL HEALTH COUNSELOR