Provider Demographics
NPI:1487898144
Name:CARE COUNSELING & PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:CARE COUNSELING & PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CANTY
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, LPC
Authorized Official - Phone:404-734-0954
Mailing Address - Street 1:4319 COVINGTON HWY
Mailing Address - Street 2:SUITE 214
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-1210
Mailing Address - Country:US
Mailing Address - Phone:404-284-1191
Mailing Address - Fax:404-284-1807
Practice Address - Street 1:4319 COVINGTON HWY
Practice Address - Street 2:SUITE 214
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-1210
Practice Address - Country:US
Practice Address - Phone:404-284-1191
Practice Address - Fax:404-284-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-26
Last Update Date:2009-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002129101YP2500X
GAPSY003237103TC1900X
GALPC004261101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA316802580Medicaid