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General NPI Number Information
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NPI Number | 1144724055
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Entity Type | Organization
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Legal Business Name | ENGAGE COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 03/23/2018
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Provider Practice Location Address
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Address Line | 271 S CULVER ST STE D
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4805
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Country | US
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Telephone | 404-586-4267
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Fax | 800-684-0723
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Provider Business Mailing Address
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Address Line | 6387 MOSSY OAK LNDG
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City | BRASELTON
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State | GA
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Zip | 30517-6296
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Country | US
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Telephone | 404-803-5566
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Fax | 800-684-0723
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Authorized Official
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Title or Position | OWNER
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Name | NICOLETTE NARI MARTIN
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Credential | LPC
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Telephone | 404-803-5566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC009371
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License Number State | GA
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