Healthcare Provider Details

I. General information

NPI: 1629852272
Provider Name (Legal Business Name): COUNSELING 360, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3244 SHAMROCK CT
DECATUR GA
30032-7132
US

IV. Provider business mailing address

3244 SHAMROCK CT
DECATUR GA
30032-7132
US

V. Phone/Fax

Practice location:
  • Phone: 810-869-6294
  • Fax:
Mailing address:
  • Phone: 810-869-6294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CURLISHA CREIGHTON-MUWAKKIL
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 678-632-4004