=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073668323
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARWELL COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 W PONCE DE LEON AVE SUITE 621
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30030-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-373-5326
-----------------------------------------------------
Fax | 770-929-1205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 W PONCE DE LEON AVE SUITE 621
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30030-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-373-5326
-----------------------------------------------------
Fax | 770-929-1205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PATRICIA R HARWELL
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 404-373-5326
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 000143
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------