Healthcare Provider Details

I. General information

NPI: 1386580702
Provider Name (Legal Business Name): MADE NEW COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 ELM ST NE
COVINGTON GA
30014-2429
US

IV. Provider business mailing address

2180 ELM ST NE
COVINGTON GA
30014-2429
US

V. Phone/Fax

Practice location:
  • Phone: 478-308-4511
  • Fax:
Mailing address:
  • Phone: 478-308-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHARMION LETITIA ROBERTS
Title or Position: OWNER
Credential: LPC, NCC
Phone: 478-308-4511