Organization Name: | CCS PSYCHOTHERAPY |
NPI Number: | 1083841415 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GALEN E COLE (LPC) |
Mailing Address: | 3121 Centerville Rosebud Rd Snellville |
State: | GA US |
Postal Code: | 300395316 |
Phone Number: | 8884757174 |
Fax Number: | 8882108891 |
NPI Enumeration Date: | 06/11/2009 |
NPI Last Update Date: | 09/24/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC003888 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |