Healthcare Provider Details

I. General information

NPI: 1215288097
Provider Name (Legal Business Name): REBUILDING LIVES COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4875 HOG MOUNTAIN RD
FLOWERY BRANCH GA
30542-3476
US

IV. Provider business mailing address

4875 HOG MOUNTAIN RD
FLOWERY BRANCH GA
30542-3476
US

V. Phone/Fax

Practice location:
  • Phone: 470-577-4630
  • Fax: 678-585-6685
Mailing address:
  • Phone: 470-577-4630
  • Fax: 678-585-6685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number005762
License Number StateGA

VIII. Authorized Official

Name: NEDRA PENLAND
Title or Position: OWNER
Credential:
Phone: 470-577-4630