Provider Demographics
NPI:1427104751
Name:JOHN'S CREEK COUNSELING, L.L.C.
Entity type:Organization
Organization Name:JOHN'S CREEK COUNSELING, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-557-4144
Mailing Address - Street 1:5000 RESEARCH CT
Mailing Address - Street 2:SUITE 725
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6609
Mailing Address - Country:US
Mailing Address - Phone:678-557-4144
Mailing Address - Fax:
Practice Address - Street 1:5000 RESEARCH CT
Practice Address - Street 2:SUITE 725
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6609
Practice Address - Country:US
Practice Address - Phone:678-557-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0295751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty