Healthcare Provider Details

I. General information

NPI: 1992344584
Provider Name (Legal Business Name): IMPROVED INSIGHT COUNSELING SERVICES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E MAIN ST STE M
CANTON GA
30114-2759
US

IV. Provider business mailing address

270 E MAIN ST STE M
CANTON GA
30114-2759
US

V. Phone/Fax

Practice location:
  • Phone: 470-361-9494
  • Fax:
Mailing address:
  • Phone: 470-361-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN CARSON
Title or Position: CEO/CFO
Credential: LPC, NCC
Phone: 470-361-9494