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General NPI Number Information
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NPI Number | 1336722560
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED CONCEPTS IN COUNSELING & CONSULTING, INC
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 1860 SILVERSTONE DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7270
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Country | US
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Telephone | 248-470-7279
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Fax | 678-689-1132
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Provider Business Mailing Address
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Address Line | 1860 SILVERSTONE DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7270
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SAMUEL CRAIG
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Credential | PHD
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Telephone | 248-470-7279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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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