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General NPI Number Information
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NPI Number | 1003429663
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Entity Type | Organization
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Legal Business Name | A BALANCED PLACE, LLC
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 4247 SKYLINE VW
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City | OAKWOOD
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State | GA
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Zip | 30566-4307
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Country | US
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Telephone | 678-387-9076
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Fax | 678-807-2834
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Provider Business Mailing Address
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Address Line | 4247 SKYLINE VW
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City | OAKWOOD
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State | GA
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Zip | 30566-4307
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Country | US
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Telephone | 678-387-9076
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Fax | 678-807-2834
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARYL DURBIN
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Credential | PH.D LPC
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Telephone | 678-387-9076
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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 |
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License Number State |
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