Healthcare Provider Details

I. General information

NPI: 1871003806
Provider Name (Legal Business Name): WATTERS COUNSELING & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E 5TH AVE # A4
ROME GA
30161-1722
US

IV. Provider business mailing address

325 GRANT RD NE
ARMUCHEE GA
30105-2622
US

V. Phone/Fax

Practice location:
  • Phone: 404-583-2439
  • Fax: 706-291-1870
Mailing address:
  • Phone: 404-583-2439
  • Fax: 706-291-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004681
License Number StateGA

VIII. Authorized Official

Name: LATONYA J WATTERS
Title or Position: OWNER
Credential: LPC
Phone: 404-583-2439