Healthcare Provider Details

I. General information

NPI: 1467342907
Provider Name (Legal Business Name): URBAN GATHERING COUNSELING LTD CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11720 AMBER PARK DR STE 160
ALPHARETTA GA
30009-2271
US

IV. Provider business mailing address

10620 COLONY GLEN DR
ALPHARETTA GA
30022-4914
US

V. Phone/Fax

Practice location:
  • Phone: 334-552-1846
  • Fax:
Mailing address:
  • Phone: 334-552-1846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JOCLYN WINDOM
Title or Position: PRINCIPLE CLINICIAN/OWNER
Credential: LPC
Phone: 334-552-1846