Healthcare Provider Details

I. General information

NPI: 1851712640
Provider Name (Legal Business Name): RESTORATION COUNSELING OF ATLANTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 COLONIAL PARK DR STE 102
ROSWELL GA
30075-3760
US

IV. Provider business mailing address

102 MACY DR
ROSWELL GA
30076-6329
US

V. Phone/Fax

Practice location:
  • Phone: 678-534-3824
  • Fax: 678-281-1690
Mailing address:
  • Phone: 678-534-3824
  • Fax: 678-281-1690

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 Code305S00000X
TaxonomyPoint of Service
License NumberLPC 004704
License Number StateGA

VIII. Authorized Official

Name: MRS. JENNIFER L STUCKERT
Title or Position: MANAGER
Credential: MA MFT, LPC
Phone: 678-534-3824