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General NPI Number Information
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NPI Number | 1205545696
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Entity Type | Organization
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Legal Business Name | SILVER CYPRESS GROUP, LLC
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 515 WOODWARD DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-7641
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Country | US
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Telephone | 770-823-2636
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Fax |
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Provider Business Mailing Address
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Address Line | 515 WOODWARD DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-7641
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Country | US
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Telephone | 770-823-2636
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Fax |
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Authorized Official
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Title or Position | FOUNDER, CLINICAL DIRECTOR
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Name | NICOLE YAKSH
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Credential | LPC, NCC, CCTP
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Telephone | 770-823-2636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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