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General NPI Number Information
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NPI Number | 1114892726
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Entity Type | Organization
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Legal Business Name | THE RESET ROOM COUNSELING AND COACHING LLC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 4172 EDENBROOKE CIR
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City | LOGANVILLE
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State | GA
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Zip | 30052-5193
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Country | US
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Telephone | 770-231-5412
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Fax |
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Provider Business Mailing Address
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Address Line | 267 LANGLEY DR # 1299
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-6907
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Country | US
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Telephone | 770-231-5412
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MISS NAKIA S WILDER
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Credential | LCSW
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Telephone | 770-231-5412
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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 |
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License Number State |
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