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General NPI Number Information
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NPI Number | 1003259334
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Entity Type | Organization
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Legal Business Name | JOURNEYS COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 04/17/2013
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 200 S CARROLL RD
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City | VILLA RICA
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State | GA
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Zip | 30180-2606
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Country | US
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Telephone | 404-452-3789
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Fax |
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Provider Business Mailing Address
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Address Line | 200 S CARROLL RD
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City | VILLA RICA
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State | GA
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Zip | 30180-2606
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Country | US
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Telephone | 404-452-3789
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | ROBERT DAVID RUSSELL
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Credential | LPC
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Telephone | 404-452-3789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC004424,LPC004531
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License Number State | GA
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