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General NPI Number Information
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NPI Number | 1255578662
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Entity Type | Organization
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Legal Business Name | COUNSELING AND LIFE COACH SERVICES LLC
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 3455 LAWRENCEVILLE SUWANEE RD SUITE D
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City | SUWANEE
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State | GA
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Zip | 30024-6425
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Country | US
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Telephone | 404-496-5041
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Fax | 404-424-9383
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Provider Business Mailing Address
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Address Line | 722 COLLINS HILL RD SUITE H-311
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4118
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Country | US
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Telephone | 404-496-5041
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Fax | 404-424-9383
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Authorized Official
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Title or Position | OWNER (COUNSELOR)
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Name | MRS. ANDREA D SIMS
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Credential | M.ED. L.P.C.
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Telephone | 404-496-5041
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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 | LPC790
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License Number State | GA
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