Healthcare Provider Details

I. General information

NPI: 1538646401
Provider Name (Legal Business Name): SOS COUNSELING AND CONSULTATION GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 WISTERIA DR STE 440
SNELLVILLE GA
30078-6160
US

IV. Provider business mailing address

2336 WISTERIA DR STE 440
SNELLVILLE GA
30078-6160
US

V. Phone/Fax

Practice location:
  • Phone: 770-733-1469
  • Fax:
Mailing address:
  • Phone: 770-733-1469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberCSW005953
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. KABIAN BROWN
Title or Position: OWNER
Credential: LCSW
Phone: 210-560-0959