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General NPI Number Information
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NPI Number | 1083124762
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Entity Type | Organization
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Legal Business Name | GRACEOL COUNSELING CENTER INC
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1035 HONEY CREEK RD SE
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City | CONYERS
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State | GA
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Zip | 30013-2948
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Country | US
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Telephone | 404-839-2688
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Fax | 770-922-9498
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Provider Business Mailing Address
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Address Line | 1035 HONEY CREEK RD SE
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City | CONYERS
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State | GA
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Zip | 30013-2948
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Country | US
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Telephone | 404-839-2688
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Fax | 770-922-9498
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Authorized Official
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Title or Position | CEO
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Name | MS. YEMI JOKE SOWEMIMO
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Credential | FNP-C
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Telephone | 404-839-2688
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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 | RN229849
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License Number State | GA
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