Healthcare Provider Details

I. General information

NPI: 1174999338
Provider Name (Legal Business Name): CAUSEY DUBOISE CAMPBELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 BOULDERCREST RD SE
ATLANTA GA
30316-3503
US

IV. Provider business mailing address

1430 BOULDERCREST RD SE
ATLANTA GA
30316-3503
US

V. Phone/Fax

Practice location:
  • Phone: 404-437-0754
  • Fax: 866-239-8271
Mailing address:
  • Phone: 404-437-0754
  • Fax: 866-239-8271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number04181508R2
License Number StateGA

VIII. Authorized Official

Name: HETTIE JEAN DUBOISE
Title or Position: PARACLETOS COUNSELING SPECIALIST
Credential: M.A.
Phone: 404-437-0754