Healthcare Provider Details

I. General information

NPI: 1952947517
Provider Name (Legal Business Name): DECEMBER SESSION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 N EXPRESSWAY STE B
GRIFFIN GA
30223-1185
US

IV. Provider business mailing address

1815 N EXPRESSWAY STE B
GRIFFIN GA
30223-1185
US

V. Phone/Fax

Practice location:
  • Phone: 678-408-4640
  • Fax:
Mailing address:
  • Phone: 678-408-4640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: