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General NPI Number Information
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NPI Number | 1215579933
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Entity Type | Organization
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Legal Business Name | LIVING IN FREEDOM COUNSELING
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Dates
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Enumeration Date | 10/14/2019
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 911 N TENNESSEE ST
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City | CARTERSVILLE
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State | GA
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Zip | 30120-8514
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Country | US
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Telephone | 770-765-0988
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Fax | 770-621-9952
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Provider Business Mailing Address
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Address Line | 2540 RIDGECREST DR NW
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City | KENNESAW
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State | GA
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Zip | 30152-3439
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Country | US
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Telephone | 770-864-6847
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Fax |
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Authorized Official
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Title or Position | CO OWNER OF LIVING IN FREEDOM
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Name | CYNTHIA RUSSELL
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Credential | LCSW
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Telephone | 770-864-6847
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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 |
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License Number State |
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