| Cherokee Center For Change Counseling, Inc. | |
|
409 Old Boring Lane Woodstock GA 30189-2495 | |
| (770) 928-7300 | |
| (770) 928-7558 |
| Full Name | Cherokee Center For Change Counseling, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 409 Old Boring Lane, Woodstock, Georgia |
| Authorized Official Name and Position | Ita Dore (DIRECTOR) |
| Authorized Official Contact | 7709287300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cherokee Center For Change Counseling, Inc. 409 Old Boring Ln Woodstock GA 30189-2495 Ph: (770) 928-7300 | Cherokee Center For Change Counseling, Inc. 409 Old Boring Lane Woodstock GA 30189-2495 Ph: (770) 928-7300 |
| NPI Number | 1073892923 |
|---|---|
| Provider Enumeration Date | 08/10/2011 |
| Last Update Date | 08/10/2011 |
| Medicare PECOS PAC ID | 5698149151 |
|---|---|
| Medicare Enrollment ID | O20230323001887 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073892923 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 2347 (Georgia) | Primary |
| Provider Name | Ita G. Dore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427374255 PECOS PAC ID: 6507230067 Enrollment ID: I20230401000085 |
| Provider Name | Elizabeth Abbot Shaw |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326686643 PECOS PAC ID: 7517332455 Enrollment ID: I20230407000134 |
| Provider Name | Cindy Hatfield Fruits |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679926950 PECOS PAC ID: 5193168649 Enrollment ID: I20240212002574 |
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