Healthcare Provider Details

I. General information

NPI: 1205563384
Provider Name (Legal Business Name): NORTHWEST COUNSELING PROFESSIONALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 WENDY BAGWELL PKWY STE 811
HIRAM GA
30141-7819
US

IV. Provider business mailing address

5604 WENDY BAGWELL PKWY STE 811
HIRAM GA
30141-7819
US

V. Phone/Fax

Practice location:
  • Phone: 678-720-2119
  • Fax: 678-730-7242
Mailing address:
  • Phone: 678-720-2119
  • Fax: 678-730-7242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CARLA GARVIN
Title or Position: THERAPIST
Credential: PHD, LPC, NCC, CACII
Phone: 678-365-7243