Healthcare Provider Details

I. General information

NPI: 1689286130
Provider Name (Legal Business Name): RADANDEL COMMUNITY COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 MILSTEAD RD NE
CONYERS GA
30012-3824
US

IV. Provider business mailing address

1315 MILSTEAD RD NE
CONYERS GA
30012-3824
US

V. Phone/Fax

Practice location:
  • Phone: 470-545-0860
  • Fax: 470-300-7778
Mailing address:
  • Phone: 470-545-0860
  • Fax: 470-300-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ELLA MICHELLE STEPHENSON
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 470-545-0860