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General NPI Number Information
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NPI Number | 1306535505
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Entity Type | Organization
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Legal Business Name | LIVE OAK COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 97 KEYS FERRY ST
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City | MCDONOUGH
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State | GA
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Zip | 30253-3228
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Country | US
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Telephone | 470-205-2665
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Fax |
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Provider Business Mailing Address
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Address Line | 213 CECIL WAY
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City | MCDONOUGH
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State | GA
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Zip | 30252-7432
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Country | US
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Telephone | 470-464-6124
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | AMBER FLANNERY
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Credential | MA, LPC CPCS
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Telephone | 470-464-6124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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