Healthcare Provider Details

I. General information

NPI: 1376953364
Provider Name (Legal Business Name): POPE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 PRISM DR., SUITE 11
CARROLLTON GA
30116
US

IV. Provider business mailing address

251 PRISM DR., SUITE 11
CARROLLTON GA
30116
US

V. Phone/Fax

Practice location:
  • Phone: 678-447-4289
  • Fax: 770-830-0592
Mailing address:
  • Phone: 678-447-4289
  • Fax: 770-830-0592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. HARRIS TODD POPE
Title or Position: OWNER/OPERATOR
Credential: NCAC II
Phone: 678-447-4289