Healthcare Provider Details

I. General information

NPI: 1588360051
Provider Name (Legal Business Name): WAYPOINT PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 05/29/2023
Certification Date: 05/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 SHILOH RD NW STE 2160
KENNESAW GA
30144-7185
US

IV. Provider business mailing address

1275 SHILOH RD NW STE 2160
KENNESAW GA
30144-7185
US

V. Phone/Fax

Practice location:
  • Phone: 404-578-3145
  • Fax:
Mailing address:
  • Phone: 404-578-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: TODD B HUDSON
Title or Position: DIRECTOR
Credential: LPC
Phone: 404-578-3145