| Canton Counseling, LLC | |
|
310 Paper Trail Way Suite 106 Canton GA 30115-5203 | |
| (678) 880-4645 | |
| (770) 628-0046 |
| Full Name | Canton Counseling, LLC |
|---|---|
| Speciality | Counselor |
| Location | 310 Paper Trail Way, Canton, Georgia |
| Authorized Official Name and Position | Kristen Fraser (OWNER) |
| Authorized Official Contact | 6788804645 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Canton Counseling, LLC 310 Paper Trail Way Suite 106 Canton GA 30115-5203 Ph: (678) 880-4645 | Canton Counseling, LLC 310 Paper Trail Way Suite 106 Canton GA 30115-5203 Ph: (678) 880-4645 |
| NPI Number | 1780014720 |
|---|---|
| Provider Enumeration Date | 11/12/2013 |
| Last Update Date | 11/12/2013 |
| Medicare PECOS PAC ID | 9830639749 |
|---|---|
| Medicare Enrollment ID | O20240906000206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780014720 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC005635 (Georgia) | Primary |
| Provider Name | Mary Grove |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043648694 PECOS PAC ID: 3375083108 Enrollment ID: I20240909000455 |
| Provider Name | Martha Taylor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417520826 PECOS PAC ID: 5991245631 Enrollment ID: I20240910000564 |
| Provider Name | Amy Brockman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710462874 PECOS PAC ID: 5698215234 Enrollment ID: I20240910000674 |
| Provider Name | Erin Taylor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023258720 PECOS PAC ID: 7810437464 Enrollment ID: I20240910000866 |
| Provider Name | Frank Valenti |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669426524 PECOS PAC ID: 3971522012 Enrollment ID: I20240913003161 |
| Provider Name | Derek Struchtemeyer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215365663 PECOS PAC ID: 7517408321 Enrollment ID: I20240920000242 |
| Provider Name | Kristen Fraser |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922389279 PECOS PAC ID: 8426598335 Enrollment ID: I20240930000600 |
| Provider Name | Lauren Moss |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023786886 PECOS PAC ID: 9739684804 Enrollment ID: I20250929000621 |
| Provider Name | Jennifer-linda S Saccoccia |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710672811 PECOS PAC ID: 5597262451 Enrollment ID: I20251007003580 |
| Provider Name | Noelle Beard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629448857 PECOS PAC ID: 5294225223 Enrollment ID: I20251110004047 |
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