NPIMap

Organization Active NPI

Panacea Counseling Services LLC

  • Community/Behavioral Health Agency
  • Riverdale, GA
National Provider Identifier
1013249283
Registry record updated Feb 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
LPC005841 Issued in GA
Legal business name
PANACEA COUNSELING SERVICES LLC
Practice address
1436 King Rd
Riverdale, GA 30296-2915
Phone
(404) 510-9358
NPI assigned
Feb 12, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carlton Gray
Title
Co-Founder
Phone
(404) 723-4644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X LPC005841 GA Primary

Addresses

Primary practice location

1436 King Rd
Riverdale, GA 30296-2915

Mailing address

5436 Glen Haven Dr
College Park, GA 30349-6481
Phone (404) 936-3126

National Provider Directory

National Provider Directory
Tax ID family
Panacea Counseling Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265932800000",
    "number": "1013249283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5436 GLEN HAVEN DR",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303496481",
            "telephone_number": "404-936-3126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1436 KING RD",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302962915",
            "telephone_number": "404-510-9358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANACEA COUNSELING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-12",
        "last_updated": "2010-02-12",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "CARLTON",
        "authorized_official_title_or_position": "CO-FOUNDER",
        "authorized_official_telephone_number": "404-723-4644"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "LPC005841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.