Healthcare Provider Details

I. General information

NPI: 1972641538
Provider Name (Legal Business Name): PARACLETE COUNSELING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 JOHNS CREEK CT SUITE 260
SUWANEE GA
30024-1224
US

IV. Provider business mailing address

3905 JOHNS CREEK CT SUITE 260
SUWANEE GA
30024-1224
US

V. Phone/Fax

Practice location:
  • Phone: 770-753-0350
  • Fax: 770-497-9536
Mailing address:
  • Phone: 770-753-0350
  • Fax: 770-497-9536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1741
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA G POORE
Title or Position: PRESIDENT
Credential: MS, LPC
Phone: 770-753-0350