Healthcare Provider Details

I. General information

NPI: 1134554488
Provider Name (Legal Business Name): VISTA COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 10/03/2021
Certification Date: 10/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 SYRUP MILL DR.
DAHLONEGA GA
30533-2788
US

IV. Provider business mailing address

PO BOX 1394
DAHLONEGA GA
30533
US

V. Phone/Fax

Practice location:
  • Phone: 706-338-1291
  • Fax:
Mailing address:
  • Phone: 706-338-1291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004876
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004726
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHE PISARIK
Title or Position: COUNSELOR
Credential: PH.D.
Phone: 706-338-7300