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General NPI Number Information
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NPI Number | 1164737862
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Entity Type | Organization
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Legal Business Name | NORTH GEORGIA COUNSELING AND EDUCATION CENTER
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 08/18/2010
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Provider Practice Location Address
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Address Line | 431 GROVE ST N SUITE E
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City | DAHLONEGA
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State | GA
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Zip | 30533-0437
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Country | US
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Telephone | 706-867-6798
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Fax | 706-867-0265
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Provider Business Mailing Address
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Address Line | 431 GROVE ST N SUITE E
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City | DAHLONEGA
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State | GA
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Zip | 30533-0437
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Country | US
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Telephone | 706-867-6798
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Fax | 706-867-0265
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Authorized Official
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Title or Position | INSTRUCTOR/OWNER
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Name | MR. GARY PENNELL
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Credential |
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Telephone | 706-867-6798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 6735
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License Number State | GA
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