Healthcare Provider Details

I. General information

NPI: 1487898144
Provider Name (Legal Business Name): CARE COUNSELING & PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2009
Last Update Date: 04/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4319 COVINGTON HWY SUITE 214
DECATUR GA
30035-1210
US

IV. Provider business mailing address

4319 COVINGTON HWY SUITE 214
DECATUR GA
30035-1210
US

V. Phone/Fax

Practice location:
  • Phone: 404-284-1191
  • Fax: 404-284-1807
Mailing address:
  • Phone: 404-284-1191
  • Fax: 404-284-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC002129
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY003237
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004261
License Number StateGA

VIII. Authorized Official

Name: MS. LYDIA J CANTY
Title or Position: DIRECTOR
Credential: EDS, LPC
Phone: 404-734-0954