Healthcare Provider Details

I. General information

NPI: 1114664851
Provider Name (Legal Business Name): SENOVIA WYCHE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2022
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 CHEROKEE ST NW STE 903
KENNESAW GA
30144-6782
US

IV. Provider business mailing address

13 MERCER DR NW
CARTERSVILLE GA
30121-9259
US

V. Phone/Fax

Practice location:
  • Phone: 855-994-0478
  • Fax:
Mailing address:
  • Phone: 770-369-7261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC015825
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: