Provider Demographics
NPI:1063606598
Name:COMMUNITY COUNSELING, INC.
Entity type:Organization
Organization Name:COMMUNITY COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:B
Authorized Official - Last Name:NAMIRR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-640-1020
Mailing Address - Street 1:3950 COBB PKWY NW
Mailing Address - Street 2:SUITE 708
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-9532
Mailing Address - Country:US
Mailing Address - Phone:678-640-1020
Mailing Address - Fax:
Practice Address - Street 1:3950 COBB PKWY NW
Practice Address - Street 2:SUITE 708
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-9532
Practice Address - Country:US
Practice Address - Phone:678-640-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00000000000000000OtherAPPLIED FOR MEDICAID NUMB