=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124522818
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WECARE COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2018
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2330 SCENIC HWY S OFC SUITE
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-3115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-451-6417
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2888 BRIDLE CREEK DR SW
-----------------------------------------------------
City | CONYERS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30094-5677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-451-6417
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. LISA GUEST
-----------------------------------------------------
Credential | LPC, LMSW, CASAC
-----------------------------------------------------
Telephone | 718-451-6417
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | ALPC009668
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------