Healthcare Provider Details

I. General information

NPI: 1700472297
Provider Name (Legal Business Name): LIVE OAK COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 KEYS FERRY ST
MCDONOUGH GA
30253-3228
US

IV. Provider business mailing address

213 CECIL WAY
MCDONOUGH GA
30252-7432
US

V. Phone/Fax

Practice location:
  • Phone: 470-464-6124
  • Fax:
Mailing address:
  • Phone: 470-464-6124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMBER FLANNERY
Title or Position: DIRECTOR/COUNSELOR
Credential: LPC
Phone: 470-205-2665