Provider Demographics
NPI:1144642224
Name:AKOMA COUNSELING & CONSULTING, INC
Entity type:Organization
Organization Name:AKOMA COUNSELING & CONSULTING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:E
Authorized Official - Last Name:REESE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-378-7309
Mailing Address - Street 1:PO BOX 2639
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-2639
Mailing Address - Country:US
Mailing Address - Phone:404-378-7309
Mailing Address - Fax:404-378-7310
Practice Address - Street 1:125 E TRINITY PL
Practice Address - Street 2:SUITE 310
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3360
Practice Address - Country:US
Practice Address - Phone:404-378-7309
Practice Address - Fax:404-378-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003136066AMedicaid