| Authentic Spirit Counseling Services | |
|
2032 Maple St Carrollton GA 30117 | |
| (678) 890-6127 | |
| Not Available |
| Full Name | Authentic Spirit Counseling Services |
|---|---|
| Speciality | Counselor |
| Location | 2032 Maple St, Carrollton, Georgia |
| Authorized Official Name and Position | Tiffani Fryar (OWNER) |
| Authorized Official Contact | 6788906127 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Authentic Spirit Counseling Services 297 New Chapel Rd Whitesburg GA 30185-2803 Ph: (678) 890-6127 | Authentic Spirit Counseling Services 2032 Maple St Carrollton GA 30117 Ph: (678) 890-6127 |
| NPI Number | 1093426124 |
|---|---|
| Provider Enumeration Date | 12/09/2022 |
| Last Update Date | 07/11/2024 |
| Certification Date | 07/02/2024 |
| Medicare PECOS PAC ID | 5496198053 |
|---|---|
| Medicare Enrollment ID | O20240210000488 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093426124 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Tiffani Fryar |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043775810 PECOS PAC ID: 6305289968 Enrollment ID: I20240210000491 |
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