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General NPI Number Information
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NPI Number | 1295130037
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Entity Type | Organization
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Legal Business Name | EXPRESSYOURSELF COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 135 E MONTGOMERY ST
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City | VILLA RICA
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State | GA
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Zip | 30180-2708
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Country | US
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Telephone | 404-725-4861
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Fax | 770-995-1959
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Provider Business Mailing Address
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Address Line | 1174 PLANTATION DR
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City | VILLA RICA
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State | GA
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Zip | 30180-3936
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Country | US
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Telephone | 404-725-4861
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Fax | 770-995-1959
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Authorized Official
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Title or Position | OWNER
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Name | CAROLINE KNOTT
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Credential | LPC
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Telephone | 404-725-4861
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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 | LPC005439
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License Number State | GA
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