Healthcare Provider Details

I. General information

NPI: 1437719382
Provider Name (Legal Business Name): WESTWIND COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 JEFFERSON PKWY STE C
NEWNAN GA
30263-3165
US

IV. Provider business mailing address

6 JEFFERSON PKWY STE C
NEWNAN GA
30263-3165
US

V. Phone/Fax

Practice location:
  • Phone: 470-334-1254
  • Fax:
Mailing address:
  • Phone: 770-919-5400
  • Fax: 770-765-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN BOCCUTI
Title or Position: OWNER AND FOUNDER
Credential: MS LPC
Phone: 770-919-5400