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General NPI Number Information
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NPI Number | 1235399791
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Entity Type | Organization
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Legal Business Name | COMMUNITY COUNSELING SOLUTIONS, LLC
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 2949 PEARL ST
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City | EAST POINT
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State | GA
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Zip | 30344-4152
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Country | US
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Telephone | 404-761-2446
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Fax | 678-669-2651
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Provider Business Mailing Address
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Address Line | 2949 PEARL ST
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City | EAST POINT
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State | GA
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Zip | 30344-4152
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Country | US
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Telephone | 404-761-2446
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Fax | 678-669-2651
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. TRIPHINIA MARGARET WALLACE
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Credential | PHD. LPC
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Telephone | 404-761-2446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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