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General NPI Number Information
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NPI Number | 1194100438
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Entity Type | Organization
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Legal Business Name | ALPHA OMEGA HOLISTIC CARE & COUNSELING, LLC.
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 160 MEMORY LN
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6263
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Country | US
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Telephone | 678-561-2171
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Fax | 678-619-4399
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Provider Business Mailing Address
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Address Line | 160 MEMORY LN
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6263
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Country | US
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Telephone | 678-561-2171
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Fax | 678-619-4399
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTI HARDEMAN
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Credential | LCSW
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Telephone | 678-561-2171
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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 | CSW005202
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License Number State | GA
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