Provider Demographics
NPI:1063269082
Name:ABIDE INTEGRATIVE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:ABIDE INTEGRATIVE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANDEQUIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-536-1831
Mailing Address - Street 1:6636 SKY LEAF LN
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-6527
Mailing Address - Country:US
Mailing Address - Phone:706-466-2943
Mailing Address - Fax:
Practice Address - Street 1:6636 SKY LEAF LN
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-6527
Practice Address - Country:US
Practice Address - Phone:706-466-2943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty