Healthcare Provider Details

I. General information

NPI: 1841600871
Provider Name (Legal Business Name): DIVERSIFIED COUNSELING & COUNSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 S STONE MTN LITHONIA RD 88
STONE MOUNTAIN GA
30088-1532
US

IV. Provider business mailing address

PO BOX 614
PINE LAKE GA
30072-0614
US

V. Phone/Fax

Practice location:
  • Phone: 404-662-2466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberAPC003533
License Number StateGA

VIII. Authorized Official

Name: LOUVENIA ALFORD-LAWSON
Title or Position: CEO
Credential:
Phone: 973-851-5704