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General NPI Number Information
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NPI Number | 1356515720
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Entity Type | Organization
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Legal Business Name | COUNSELING & PRAYER USA, INC.
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 1297 CHAUCER LN NE
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City | ATLANTA
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State | GA
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Zip | 30319-1507
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Country | US
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Telephone | 678-429-9872
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Fax |
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Provider Business Mailing Address
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Address Line | 2348 WELTON PL
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City | ATLANTA
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State | GA
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Zip | 30338-5345
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Country | US
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Telephone | 678-983-4720
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. AGNES SULLIVAN
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Credential | MSC., MSW, LMSW
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Telephone | 678-429-9872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LMSW004061
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License Number State | GA
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