| 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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