Healthcare Provider Details

I. General information

NPI: 1942851662
Provider Name (Legal Business Name): JAMES SYNAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 WADE GREEN RD NW STE 414
KENNESAW GA
30144-1763
US

IV. Provider business mailing address

4255 WADE GREEN RD NW STE 414
KENNESAW GA
30144-1763
US

V. Phone/Fax

Practice location:
  • Phone: 678-213-2194
  • Fax:
Mailing address:
  • Phone: 678-213-2194
  • Fax: 678-922-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC003185
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: