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General NPI Number Information
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NPI Number | 1053833111
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Entity Type | Organization
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Legal Business Name | GEORGIA DBT, LLC
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 333 ALCOVY ST STE 6
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City | MONROE
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State | GA
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Zip | 30655-2180
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Country | US
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Telephone | 404-839-0011
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Fax | 888-533-7063
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Provider Business Mailing Address
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Address Line | PO BOX 1332
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City | DACULA
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State | GA
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Zip | 30019-0023
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Country | US
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Telephone | 404-839-0011
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Fax | 888-533-7063
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Authorized Official
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Title or Position | OWNER
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Name | ELYSSA REID
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Credential | LPC
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Telephone | 404-839-0011
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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 | GA
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