Provider Demographics
NPI:1386994275
Name:TRINITY COUNSELING ATLANTA
Entity type:Organization
Organization Name:TRINITY COUNSELING ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:TOLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:404-822-3954
Mailing Address - Street 1:215 CHURCH ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3330
Mailing Address - Country:US
Mailing Address - Phone:404-822-3954
Mailing Address - Fax:770-452-0046
Practice Address - Street 1:215 CHURCH ST
Practice Address - Street 2:SUITE 109
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3330
Practice Address - Country:US
Practice Address - Phone:404-822-3954
Practice Address - Fax:770-452-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001112106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty