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General NPI Number Information
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NPI Number | 1215288196
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Entity Type | Organization
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Legal Business Name | CHILD & ADOLESCENT RESOURCE EDUCATION SERVICES
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 3636 SHREWSBURY CT
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City | SNELLVILLE
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State | GA
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Zip | 30039-4643
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Country | US
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Telephone | 404-578-7629
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Fax | 770-783-2230
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Provider Business Mailing Address
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Address Line | 3636 SHREWSBURY CT
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City | SNELLVILLE
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State | GA
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Zip | 30039-4643
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Country | US
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Telephone | 404-578-7629
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Fax | 770-783-2230
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Authorized Official
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Title or Position | OWNER
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Name | MONICA D DOUGLAS DAVIS
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Credential | LPC, MA
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Telephone | 404-578-7629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC006209
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License Number State | GA
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