Healthcare Provider Details

I. General information

NPI: 1457451007
Provider Name (Legal Business Name): TOMMY AARON BOONE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 PEACHTREE CORNERS CIR STE 200
NORCROSS GA
30092-2748
US

IV. Provider business mailing address

71 FLOWERY BRANCH RD
KINGSTON GA
30145-1237
US

V. Phone/Fax

Practice location:
  • Phone: 770-932-7000
  • Fax: 404-793-0149
Mailing address:
  • Phone: 678-313-3549
  • Fax: 404-793-0149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002955
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: