First Response Counseling & Intervention Llc | |
6053 N Henry Blvd Suite C Stockbridge GA 30281-3081 | |
(678) 545-4285 | |
Not Available |
Full Name | First Response Counseling & Intervention Llc |
---|---|
Speciality | Counselor - Mental Health |
Location | 6053 N Henry Blvd, Stockbridge, Georgia |
Authorized Official Name and Position | Damien Kellam (PRESIDENT & CEO) |
Authorized Official Contact | 6785454285 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
First Response Counseling & Intervention Llc 6053 N Henry Blvd Suite C Stockbridge GA 30281-3081 Ph: (678) 545-4285 | First Response Counseling & Intervention Llc 6053 N Henry Blvd Suite C Stockbridge GA 30281-3081 Ph: (678) 545-4285 |
NPI Number | 1093111049 |
---|---|
Provider Enumeration Date | 11/18/2014 |
Last Update Date | 11/18/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093111049 | NPI | - | NPPES |
003134017A | Medicaid | GA | |
003134017B | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | LPC005815 (Georgia) | Primary |
101YM0800X | Counselor - Mental Health | LPC005856 (Georgia) | Secondary |
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