1518109461 NPI number — CENTER FOR COUNSELING, REHABILITATION, AND PERSONAL EVALUATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518109461 NPI number — CENTER FOR COUNSELING, REHABILITATION, AND PERSONAL EVALUATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR COUNSELING, REHABILITATION, AND PERSONAL EVALUATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518109461
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
331 ARCADO RD NW
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
LILBURN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30047-2814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-564-3230
Provider Business Mailing Address Fax Number:
770-564-3792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331 ARCADO RD NW
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LILBURN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30047-2814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-564-3230
Provider Business Practice Location Address Fax Number:
770-564-3792
Provider Enumeration Date:
03/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DOCK
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
770-564-3230

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  LPC003265 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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