Healthcare Provider Details

I. General information

NPI: 1629901764
Provider Name (Legal Business Name): ROUTLY COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2652 BACK CREEK CHASE
DACULA GA
30019-6849
US

IV. Provider business mailing address

2652 BACK CREEK CHASE
DACULA GA
30019-6849
US

V. Phone/Fax

Practice location:
  • Phone: 678-360-9639
  • Fax:
Mailing address:
  • Phone: 678-360-9639
  • 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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DAVID ROUTLY
Title or Position: OWNER
Credential: LPC
Phone: 678-360-9639