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General NPI Number Information
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NPI Number | 1023489952
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Entity Type | Organization
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Legal Business Name | INNER COACH COUNSELING
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 11/06/2015
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Provider Practice Location Address
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Address Line | 2751 BUFORD HWY NE STE 700
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City | ATLANTA
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State | GA
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Zip | 30324-3207
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Country | US
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Telephone | 404-333-2439
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Fax |
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Provider Business Mailing Address
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Address Line | 2751 BUFORD HWY NE STE 700
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City | ATLANTA
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State | GA
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Zip | 30324-3207
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Country | US
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Telephone | 404-333-2439
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | GENA GOLDEN
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Credential | MSW,LCSW,CHT
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Telephone | 404-333-2439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW005467
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License Number State | GA
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