Provider Demographics
NPI:1124776588
Name:EAST ATLANTA COUNSELING SERVICES, INC.
Entity type:Organization
Organization Name:EAST ATLANTA COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:BERRY
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:478-747-3559
Mailing Address - Street 1:PO BOX 170451
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-0451
Mailing Address - Country:US
Mailing Address - Phone:404-913-3623
Mailing Address - Fax:
Practice Address - Street 1:3499 S COBB DR SE STE 205
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4170
Practice Address - Country:US
Practice Address - Phone:404-913-3623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)