Provider Demographics
NPI:1306487194
Name:J RAPHAEL COUNSELING LLC
Entity type:Organization
Organization Name:J RAPHAEL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-291-9181
Mailing Address - Street 1:6100 LAKE FORREST DR STE 450
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3837
Mailing Address - Country:US
Mailing Address - Phone:404-291-9181
Mailing Address - Fax:
Practice Address - Street 1:6100 LAKE FORREST DR STE 450
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3837
Practice Address - Country:US
Practice Address - Phone:404-291-9181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health