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General NPI Number Information
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NPI Number | 1225870587
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Entity Type | Organization
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Legal Business Name | CAVA COUNSELING LLC
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Dates
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Enumeration Date | 06/08/2024
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Last Update Date | 06/08/2024
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Provider Practice Location Address
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Address Line | 3615 SHARON CT
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-2854
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Country | US
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Telephone | 678-697-5114
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Fax |
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Provider Business Mailing Address
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Address Line | 618 THORNTON RD STE. 3 PMB 181
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122
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Country | US
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Telephone | 678-506-1114
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TARA SANDERS
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Credential | LPC
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Telephone | 678-506-1114
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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 |
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License Number State |
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