| Canton Counseling, Llc | |
|
310 Paper Trail Way Suite 106 Canton GA 30115-5203 | |
| (678) 880-4645 | |
| (770) 628-0046 |
| Full Name | Canton Counseling, Llc |
|---|---|
| Speciality | Counselor |
| Location | 310 Paper Trail Way, Canton, Georgia |
| Authorized Official Name and Position | Kristen Fraser (OWNER) |
| Authorized Official Contact | 6788804645 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Canton Counseling, Llc 310 Paper Trail Way Suite 106 Canton GA 30115-5203 Ph: (678) 880-4645 | Canton Counseling, Llc 310 Paper Trail Way Suite 106 Canton GA 30115-5203 Ph: (678) 880-4645 |
| NPI Number | 1780014720 |
|---|---|
| Provider Enumeration Date | 11/12/2013 |
| Last Update Date | 11/12/2013 |
| Medicare PECOS PAC ID | 9830639749 |
|---|---|
| Medicare Enrollment ID | O20240906000206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780014720 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC005635 (Georgia) | Primary |
| Provider Name | Robin Joiner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285233817 PECOS PAC ID: 5294275087 Enrollment ID: I20240906003740 |
| Provider Name | Jon P Costales |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1902361553 PECOS PAC ID: 7719427533 Enrollment ID: I20240909000111 |
| Provider Name | Mary Grove |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043648694 PECOS PAC ID: 3375083108 Enrollment ID: I20240909000455 |
| Provider Name | Martha Taylor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417520826 PECOS PAC ID: 5991245631 Enrollment ID: I20240910000564 |
| Provider Name | Amy Brockman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710462874 PECOS PAC ID: 5698215234 Enrollment ID: I20240910000674 |
| Provider Name | Erin Taylor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023258720 PECOS PAC ID: 7810437464 Enrollment ID: I20240910000866 |
| Provider Name | Frank Valenti |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669426524 PECOS PAC ID: 3971522012 Enrollment ID: I20240913003161 |
| Provider Name | Derek Struchtemeyer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215365663 PECOS PAC ID: 7517408321 Enrollment ID: I20240920000242 |
| Provider Name | Kristen Fraser |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922389279 PECOS PAC ID: 8426598335 Enrollment ID: I20240930000600 |
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