Healthcare Provider Details

I. General information

NPI: 1013538164
Provider Name (Legal Business Name): SACRED CARE & COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 06/21/2020
Certification Date: 06/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 PEACHTREE CORNERS CIR STE 185
NORCROSS GA
30092-2553
US

IV. Provider business mailing address

4725 PEACHTREE CORNERS CIR STE 185
NORCROSS GA
30092-2553
US

V. Phone/Fax

Practice location:
  • Phone: 678-506-7499
  • Fax:
Mailing address:
  • Phone: 678-506-7499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TAVONDA HUDSON
Title or Position: MENTAL HEALTH THERAPIST
Credential: LPC
Phone: 678-506-7499