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General NPI Number Information
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NPI Number | 1194158253
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Entity Type | Organization
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Legal Business Name | THE COUNSELING HEALING CENTER, LLC
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 5300 MEMORIAL DR STE 141
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-3155
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Country | US
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Telephone | 404-647-2514
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Fax | 678-559-0453
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Provider Business Mailing Address
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Address Line | 5300 MEMORIAL DR STE 141
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-3155
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Country | US
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Telephone | 404-647-2514
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Fax | 678-559-0453
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Authorized Official
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Title or Position | OWNER
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Name | ANTITA CARTER
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Credential | LPC
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Telephone | 404-647-2514
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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 | LPC007059
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License Number State | GA
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