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Organization
ASFC OUTREACH THERAPEUTIC COUNSELING SERVICES, LLC
Active
Organization
ASFC OUTREACH THERAPEUTIC COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA CLARK CEO/MBA (CEO/OWNER)
(770) 787-3788
Entity
Organization
Contact information
Practice address
1755 NORTH BROWN ROAD, SUITE 200, LAWRENCEVILLE, GA 30043
(770) 787-3788
(770) 786-5159
Mailing address
1755 NORTH BROWN ROAD, SUITE 200, LAWRENCEVILLE, GA 30043
(770) 787-3788
(770) 786-5159
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
251B00000X
Case Management Agency
—
NULL
251S00000X
Community/Behavioral Health Agency
—
NULL
261QC1500X
Community Health Clinic/Center
Primary
—
NULL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
Other
Enumeration date
11/02/2017
Last updated
11/02/2017
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