Provider Demographics
NPI:1699539304
Name:LANDMARK COUNSELING LLC
Entity type:Organization
Organization Name:LANDMARK COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOKUNBO
Authorized Official - Middle Name:TOCEE
Authorized Official - Last Name:SHOKUNBI HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-610-6362
Mailing Address - Street 1:871 SEABREEZE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:GA
Mailing Address - Zip Code:30113-4474
Mailing Address - Country:US
Mailing Address - Phone:909-316-8813
Mailing Address - Fax:909-751-1145
Practice Address - Street 1:871 SEABREEZE LAKE RD
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:GA
Practice Address - Zip Code:30113-4474
Practice Address - Country:US
Practice Address - Phone:909-316-8813
Practice Address - Fax:909-751-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1396415659Medicaid