Healthcare Provider Details

I. General information

NPI: 1356246482
Provider Name (Legal Business Name): AARON ROSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 TOWN PARK LN STE 300
EVANS GA
30809-3477
US

IV. Provider business mailing address

3203 HELENA SPRINGS AVE APT E
AUGUSTA GA
30909-9330
US

V. Phone/Fax

Practice location:
  • Phone: 470-429-9264
  • Fax:
Mailing address:
  • Phone: 470-429-9264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC017486
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: