Healthcare Provider Details

I. General information

NPI: 1639939705
Provider Name (Legal Business Name): CARLOTTA CLOUD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HENRY CLOWER BLVD STE A
SNELLVILLE GA
30078-3152
US

IV. Provider business mailing address

3790 WILLOWMEADE DR
SNELLVILLE GA
30039-6307
US

V. Phone/Fax

Practice location:
  • Phone: 770-389-8100
  • Fax:
Mailing address:
  • Phone: 678-232-1178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC014566
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLPC014566
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014566
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: