Provider Demographics
NPI:1154971679
Name:CLASSIC CITY COUNSELING & CONSULTATION LLC
Entity type:Organization
Organization Name:CLASSIC CITY COUNSELING & CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WONER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:706-207-1201
Mailing Address - Street 1:145 ROLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3327
Mailing Address - Country:US
Mailing Address - Phone:706-207-1201
Mailing Address - Fax:
Practice Address - Street 1:149 ONETA ST UNIT 6C
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1873
Practice Address - Country:US
Practice Address - Phone:706-207-1201
Practice Address - Fax:770-995-1959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty