=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265937585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWLER COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2018
-----------------------------------------------------
Last Update Date | 03/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8046 ROSWELL RD STE 101C
-----------------------------------------------------
City | SANDY SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30350-3930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-580-7150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4850 WEATHERVANE DR
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30022-3746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-580-7150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TARA TOWLER-CUMBY
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 404-580-7150
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | LPC005795
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------