Organization
DESTINED TO REIGN COUNSELING SERVICES, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAMIEN KELLAM M.A.,LPC, PHD,ABD (PRESIDENT/LICENSED PSYCHOTHERAPIST)
(770) 875-6760
Entity
Organization
Contact information
Practice address
2224 LAKE HARBIN RD, MORROW, GA 30260-1907
(404) 441-7918
Mailing address
2224 LAKE HARBIN RD, MORROW, GA 30260-1907
(404) 441-7918
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC005815
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003134017A
—
GA
Enumeration date
09/30/2013
Last updated
09/30/2013
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