| Srm Counseling & Therapeutic Services, Llc | |
|
320 Maxwell Rd Suite 300 Alpharetta GA 30009-2070 | |
| (678) 371-4580 | |
| (770) 995-1959 |
| Full Name | Srm Counseling & Therapeutic Services, Llc |
|---|---|
| Speciality | Counselor |
| Location | 320 Maxwell Rd, Alpharetta, Georgia |
| Authorized Official Name and Position | Jeanette A. Mcclellan (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 6783714580 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Srm Counseling & Therapeutic Services, Llc 320 Maxwell Rd Suite 300 Alpharetta GA 30009-2070 Ph: (678) 371-4580 | Srm Counseling & Therapeutic Services, Llc 320 Maxwell Rd Suite 300 Alpharetta GA 30009-2070 Ph: (678) 371-4580 |
| NPI Number | 1396114880 |
|---|---|
| Provider Enumeration Date | 09/15/2015 |
| Last Update Date | 06/23/2016 |
| Medicare PECOS PAC ID | 0840596268 |
|---|---|
| Medicare Enrollment ID | O20160311000278 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396114880 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 005648 (Georgia) | Primary |
| Provider Name | Teawka T Fullmore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861884215 PECOS PAC ID: 8921310525 Enrollment ID: I20150710001310 |
| Provider Name | Heather Ratcliffe Martin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053786061 PECOS PAC ID: 7911204375 Enrollment ID: I20160330000267 |
| Provider Name | Ronda June |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083179725 PECOS PAC ID: 9335578483 Enrollment ID: I20200410002288 |
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