Healthcare Provider Details

I. General information

NPI: 1174267389
Provider Name (Legal Business Name): 4GROWTH COUNSELING AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W CROSSVILLE RD
ROSWELL GA
30075-2947
US

IV. Provider business mailing address

4230 HARRIS RIDGE CT
ROSWELL GA
30076-4610
US

V. Phone/Fax

Practice location:
  • Phone: 678-787-9543
  • Fax:
Mailing address:
  • Phone: 678-787-9543
  • 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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DUNIA GISELLE LOBO
Title or Position: MANAGER
Credential: MA, LPC, CPCS, RPT-S
Phone: 678-787-9543