Healthcare Provider Details

I. General information

NPI: 1518187715
Provider Name (Legal Business Name): WEST COBB COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 SOUTH COBB DR SE SUITE 4
SMYRNA GA
30080-6315
US

IV. Provider business mailing address

4015 SOUTH COBB DR SE SUITE 4
SMYRNA GA
30080-6315
US

V. Phone/Fax

Practice location:
  • Phone: 770-435-2931
  • Fax: 770-435-2942
Mailing address:
  • Phone: 770-435-2931
  • Fax: 770-435-2942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW001456
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. CARLTON D HAGGARD
Title or Position: PRESIDENT
Credential: LCSW
Phone: 770-435-2931