Healthcare Provider Details

I. General information

NPI: 1023253366
Provider Name (Legal Business Name): BILLY ADAMS, LPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 HORIZON PARK DR STE A
SUWANEE GA
30024-7256
US

IV. Provider business mailing address

1806 JIMMY DODD RD
BUFORD GA
30518-2220
US

V. Phone/Fax

Practice location:
  • Phone: 770-271-8989
  • Fax:
Mailing address:
  • Phone: 770-500-8036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC4139
License Number StateGA

VIII. Authorized Official

Name: BILLY ADAMS
Title or Position: COUNSELOR
Credential: LPC
Phone: 770-271-8989