Healthcare Provider Details

I. General information

NPI: 1326036906
Provider Name (Legal Business Name): JAMES R CIRAKY M. A. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2005
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 RIVER PARK NORTH DR
WOODSTOCK GA
30188-7835
US

IV. Provider business mailing address

PO BOX 663
HOLLY SPRINGS GA
30142-0663
US

V. Phone/Fax

Practice location:
  • Phone: 404-293-5654
  • Fax:
Mailing address:
  • Phone: 404-293-5654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1557
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: