Provider Demographics
NPI:1144724055
Name:ENGAGE COUNSELING & CONSULTING, LLC
Entity type:Organization
Organization Name:ENGAGE COUNSELING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLETTE
Authorized Official - Middle Name:NARI
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-803-5566
Mailing Address - Street 1:6387 MOSSY OAK LNDG
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-6296
Mailing Address - Country:US
Mailing Address - Phone:404-803-5566
Mailing Address - Fax:800-684-0723
Practice Address - Street 1:271 S CULVER ST STE D
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4805
Practice Address - Country:US
Practice Address - Phone:404-586-4267
Practice Address - Fax:800-684-0723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009371251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health