Healthcare Provider Details

I. General information

NPI: 1851835094
Provider Name (Legal Business Name): NADINE POPE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 PARKWAY NORTH BLVD SUITE C
CUMMING GA
30040-1430
US

IV. Provider business mailing address

5965 PARKWAY NORTH BLVD SUITE C
CUMMING GA
30040-1430
US

V. Phone/Fax

Practice location:
  • Phone: 770-886-5700
  • Fax: 770-886-0404
Mailing address:
  • Phone: 770-886-5700
  • Fax: 770-886-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCSW005889
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: