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General NPI Number Information
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NPI Number | 1316243975
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Entity Type | Organization
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Legal Business Name | PHOENIX AND PEARL COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 01/31/2011
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Last Update Date | 01/31/2011
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Provider Practice Location Address
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Address Line | 1708 PEACHTREE ST NW SUITE 505
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City | ATLANTA
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State | GA
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Zip | 30309-2434
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Country | US
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Telephone | 404-901-5889
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Fax | 404-872-0925
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Provider Business Mailing Address
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Address Line | 1708 PEACHTREE ST NW SUITE 505
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City | ATLANTA
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State | GA
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Zip | 30309-2434
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Country | US
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Telephone | 404-901-5889
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Fax | 404-872-0925
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Authorized Official
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Title or Position | THERAPIST
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Name | TANYA ELISE ALEXANDER
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Credential | LMFT, ATR-BC
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Telephone | 404-901-5889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT001071
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License Number State | GA
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