MEDICARE: COUNSELING CONNECTION AND SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4394	GA

General Provider Information

NPI Number	:	1295706547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING CONNECTION AND SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 881
Second Line	:
City	:	BREMEN
State	:	GA
Zip	:	30110-0881
Country	:	US
Telephone Number	:	404-502-8664
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 S CANDLER ST
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-2603
Country	:	US
Telephone Number	:	404-502-8664
Fax Number	:

Authorized Official
Title or Position	:	GENERAL MANAGER/CEO
Name	:	MR. ERIC DANSBY
Credential	:	LPC
Telephone Number	:	404-502-8664

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	08/22/2020

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