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General NPI Number Information
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NPI Number | 1053726265
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Entity Type | Organization
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Legal Business Name | A CHRISTIAN PLACE COUNSELING
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 06/25/2014
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Provider Practice Location Address
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Address Line | 220 LANIER AVE E
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1604
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Country | US
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Telephone | 678-709-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 4109 MERRICK DR
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-6665
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Country | US
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Telephone | 678-790-9555
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Fax |
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Authorized Official
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Title or Position | OWNER / THERAPIST
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Name | JESSE GAINSBRUGH
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Credential | LPC
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Telephone | 678-709-5555
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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 | LPC007774
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License Number State | GA
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