| The Counseling Collaborative | |
|
1109 S Park St Ste 504367 Carrollton GA 30117-4462 | |
| (678) 664-3434 | |
| Not Available |
| Full Name | The Counseling Collaborative |
|---|---|
| Speciality | Counselor |
| Location | 1109 S Park St Ste 504367, Carrollton, Georgia |
| Authorized Official Name and Position | Austen Bingham (OWNER/DIRECTOR) |
| Authorized Official Contact | 6786643434 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Counseling Collaborative 1109 S Park St Ste 504367 Carrollton GA 30117-4462 Ph: (678) 664-3434 | The Counseling Collaborative 1109 S Park St Ste 504367 Carrollton GA 30117-4462 Ph: (678) 664-3434 |
| NPI Number | 1982238119 |
|---|---|
| Provider Enumeration Date | 02/26/2020 |
| Last Update Date | 05/04/2022 |
| Certification Date | 05/04/2022 |
| Medicare PECOS PAC ID | 5294172748 |
|---|---|
| Medicare Enrollment ID | O20240320002249 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982238119 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Robin W Gordon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699367987 PECOS PAC ID: 5698112159 Enrollment ID: I20240320002486 |
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