Provider Demographics
NPI:1104980895
Name:FIRST STEP COUNSELING SERVICES
Entity type:Organization
Organization Name:FIRST STEP COUNSELING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HANKERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:678-890-5960
Mailing Address - Street 1:1810 WATER PL SE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2048
Mailing Address - Country:US
Mailing Address - Phone:678-890-5960
Mailing Address - Fax:770-701-3829
Practice Address - Street 1:1810 WATER PL SE
Practice Address - Street 2:SUITE 110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2048
Practice Address - Country:US
Practice Address - Phone:678-890-5960
Practice Address - Fax:770-701-3829
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST STEP COUNSELING SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-20
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA690655725A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA690655726AMedicaid