Healthcare Provider Details

I. General information

NPI: 1063353092
Provider Name (Legal Business Name): THE COUNSELING CENTER AT DULUTH GA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4191 PLEASANT HILL RD STE 100
DULUTH GA
30096-1411
US

IV. Provider business mailing address

PO BOX 1575
LAKEWOOD NJ
08701-1018
US

V. Phone/Fax

Practice location:
  • Phone: 470-704-5010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATHIAS DEUTSCH
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 732-684-4749