Healthcare Provider Details

I. General information

NPI: 1821542614
Provider Name (Legal Business Name): ESPERANZA COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E WALNUT AVE SUITE 112
DALTON GA
30721-4406
US

IV. Provider business mailing address

415 E WALNUT AVE SUITE 112
DALTON GA
30721-4406
US

V. Phone/Fax

Practice location:
  • Phone: 423-208-0630
  • Fax:
Mailing address:
  • Phone: 423-208-0630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC008648
License Number StateGA

VIII. Authorized Official

Name: RACHEL LASKOWSKE
Title or Position: MANAGER
Credential: L.P.C.
Phone: 423-208-0630