1902572159 NPI number — COUNSELING & PSYCHOLOGICAL CONSULTING, LLC

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 1902572159 NPI number — COUNSELING & PSYCHOLOGICAL CONSULTING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING & PSYCHOLOGICAL CONSULTING, LLC
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:
1902572159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
414 MCAFEE CT NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNESAW
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30144-3811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-788-7980
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 TOWNPARK DR NW
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144-3014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-388-3379
Provider Business Practice Location Address Fax Number:
770-628-7316
Provider Enumeration Date:
08/18/2021

Additional Information

Authorized Official

Authorized Official Last Name:
STELZER
Authorized Official First Name:
ALINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
678-388-3379

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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