Healthcare Provider Details

I. General information

NPI: 1710248786
Provider Name (Legal Business Name): NORTH GEORGIA COUNSELING GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ATLANTA HWY SUITE 1901
CUMMING GA
30040-8099
US

IV. Provider business mailing address

2450 ATLANTA HWY SUITE 1901
CUMMING GA
30040-8099
US

V. Phone/Fax

Practice location:
  • Phone: 770-548-3034
  • Fax:
Mailing address:
  • Phone: 770-548-3034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: SARAH BRYAN
Title or Position: LLC OWNER
Credential: BCCC, CTC
Phone: 770-548-3034