Healthcare Provider Details

I. General information

NPI: 1548730047
Provider Name (Legal Business Name): REBECCA MARIA HULS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 LEGACY PARK BLVD NW STE D100
KENNESAW GA
30144-7322
US

IV. Provider business mailing address

420 SOUTHSHORE LN
DALLAS GA
30157-4101
US

V. Phone/Fax

Practice location:
  • Phone: 404-884-2080
  • Fax:
Mailing address:
  • Phone: 770-826-7355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC009825
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: