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General NPI Number Information
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NPI Number | 1114550571
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Entity Type | Individual
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Provider Name | CECILE MARIA DUNKLEY LAYNE
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Gender | Female
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Dates
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Enumeration Date | 02/13/2020
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | 255 CORPORTE DRIVE
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City | STOCKBRIDGE
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State | GA
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Zip | 30281
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Country | US
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Telephone | 678-982-4483
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Fax |
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Provider Business Mailing Address
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Address Line | 1785 FIELDING WAY
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City | HAMPTON
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State | GA
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Zip | 30228-3400
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Country | US
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Telephone | 203-512-3094
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LPC011425
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License Number State | GA
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