MEDICARE: BALANCED PATH COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1023478187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCED PATH COUNSELING

Provider Business Mailing Address
First Line	:	1220 WITHAM DR
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-3335
Country	:	US
Telephone Number	:	770-833-6052
Fax Number	:

Provider Business Practice Location Address
First Line	:	8046 ROSWELL RD
Second Line	:	STE 101C
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-7023
Country	:	US
Telephone Number	:	770-833-6052
Fax Number	:	877-262-0792

Authorized Official
Title or Position	:	OWNER
Name	:	HERBERT COLE
Credential	:	LPC
Telephone Number	:	770-833-6052

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	03/02/2016

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