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General NPI Number Information
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NPI Number | 1114205762
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Entity Type | Organization
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Legal Business Name | PAK COUNSELING LLC
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 3455 LAWRENCEVILLE SUWANEE RD STE D
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City | SUWANEE
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State | GA
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Zip | 30024-6425
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Country | US
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Telephone | 404-966-9413
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Fax |
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Provider Business Mailing Address
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Address Line | 3455 LAWRENCEVILLE SUWANEE RD STE D
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City | SUWANEE
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State | GA
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Zip | 30024-6425
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Country | US
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Telephone | 404-966-9413
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. UNSON PAK
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Credential | LCSW
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Telephone | 404-966-9413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003788
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License Number State | GA
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