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General NPI Number Information
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NPI Number | 1104248814
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Entity Type | Organization
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Legal Business Name | SYNERGY COUNSELING,LLC
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 1780 CENTURY BLVD NE
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City | ATLANTA
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State | GA
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Zip | 30345
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Country | US
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Telephone | 404-518-0101
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Fax | 404-266-7459
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Provider Business Mailing Address
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Address Line | 4330 GEORGETOWN SQUARE
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City | ATLANTA
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State | GA
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Zip | 30338
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Country | US
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Telephone | 404-364-2240
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. L MATT WILSON
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Credential |
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Telephone | 404-364-2240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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