Healthcare Provider Details

I. General information

NPI: 1780483784
Provider Name (Legal Business Name): NUSOUL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 WALL STREET WAY UNIT 2
TOCCOA GA
30577-6236
US

IV. Provider business mailing address

46 WALL STREET WAY UNIT 2
TOCCOA GA
30577-6236
US

V. Phone/Fax

Practice location:
  • Phone: 770-990-3754
  • Fax:
Mailing address:
  • Phone: 770-990-3754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PATTI SHIPP
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 770-990-3754