Provider Demographics
NPI:1538810338
Name:COUNSELING CENTER AT ROSWELL LLC
Entity type:Organization
Organization Name:COUNSELING CENTER AT ROSWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHELALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-285-4035
Mailing Address - Street 1:PO BOX 27091
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-6791
Mailing Address - Country:US
Mailing Address - Phone:470-704-5080
Mailing Address - Fax:470-704-5081
Practice Address - Street 1:419 E CROSSVILLE RD STE 105
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5807
Practice Address - Country:US
Practice Address - Phone:470-704-5080
Practice Address - Fax:470-704-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder