Healthcare Provider Details

I. General information

NPI: 1497081749
Provider Name (Legal Business Name): ADVANCED COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 LASSITER ROAD SUITE A-150
MARIETTA GA
30062
US

IV. Provider business mailing address

2820 LASSITER ROAD SUITE A-150
MARIETTA GA
30062
US

V. Phone/Fax

Practice location:
  • Phone: 678-585-9260
  • Fax: 678-585-9261
Mailing address:
  • Phone: 678-585-9260
  • Fax: 678-585-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004195
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT637
License Number StateLA

VIII. Authorized Official

Name: DR. RENEA J OSENI
Title or Position: OWNER/THERAPIST
Credential: PHD
Phone: 678-585-9260