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General NPI Number Information
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NPI Number | 1033749437
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Entity Type | Organization
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Legal Business Name | PRISM COUNSELING SERVICES
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 15 LAGRANGE ST STE C
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City | NEWNAN
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State | GA
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Zip | 30263-2693
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Country | US
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Telephone | 470-421-9459
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Fax |
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Provider Business Mailing Address
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Address Line | 23 WESLEY ST
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City | NEWNAN
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State | GA
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Zip | 30263-2012
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Country | US
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Telephone | 404-375-2675
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANNA NANCE
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Credential | LPC
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Telephone | 404-375-2675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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