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General NPI Number Information
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NPI Number | 1437408127
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Entity Type | Organization
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Legal Business Name | CROSBY MITCHELL COUNSELING SERVICES LLP
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Dates
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Enumeration Date | 09/10/2012
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Last Update Date | 09/10/2012
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Provider Practice Location Address
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Address Line | 315 W SOLOMON ST SUITE 210
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City | GRIFFIN
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State | GA
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Zip | 30223-3038
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Country | US
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Telephone | 770-233-2809
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Fax | 770-233-2810
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Provider Business Mailing Address
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Address Line | 315 W SOLOMON ST SUITE 210
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City | GRIFFIN
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State | GA
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Zip | 30223-3038
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Country | US
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Telephone | 770-233-2809
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Fax | 770-233-2810
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | ANGELA OREM
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Credential |
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Telephone | 770-233-2809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT001185
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0406
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | APC002290
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC001607
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License Number State | GA
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