=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245984178
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PIECES TO PEACE COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2022
-----------------------------------------------------
Last Update Date | 02/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2780 PINESTREAM DR NE
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30068-3542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-227-2464
-----------------------------------------------------
Fax | 678-606-2670
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2146 ROSWELL ROAD SUITE 108 PMB 1113
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30062-3815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-227-2464
-----------------------------------------------------
Fax | 678-606-2670
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | MRS. LESLIE DANIELLE ARROWSMITH
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 478-227-2464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------