Healthcare Provider Details

I. General information

NPI: 1710012018
Provider Name (Legal Business Name): CARE AND COUNSELING CENTER OF GEORGIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 CLAIRMONT RD
DECATUR GA
30033-3405
US

IV. Provider business mailing address

1814 CLAIRMONT RD
DECATUR GA
30033-3405
US

V. Phone/Fax

Practice location:
  • Phone: 404-636-1457
  • Fax: 404-636-7449
Mailing address:
  • Phone: 404-636-1457
  • Fax: 404-636-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. SANDRA A MULLINS
Title or Position: EXECUTIVE DIRECTOR
Credential: REVEREND
Phone: 404-636-1457