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General NPI Number Information
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NPI Number | 1356734404
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Entity Type | Organization
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Legal Business Name | GEORGIA AGAPE INC.
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Dates
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Enumeration Date | 03/13/2015
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Last Update Date | 03/13/2015
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Provider Practice Location Address
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Address Line | 3094 MERCER UNIVERSITY DR SUITE 200
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City | ATLANTA
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State | GA
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Zip | 30341-4141
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Country | US
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Telephone | 770-452-9995
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Fax | 770-457-3623
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Provider Business Mailing Address
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Address Line | 3094 MERCER UNIVERSITY DR SUITE 200
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City | ATLANTA
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State | GA
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Zip | 30341-4141
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Country | US
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Telephone | 770-452-9995
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Fax | 770-457-3623
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Authorized Official
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Title or Position | DIRECTOR OF COUNSELING
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Name | JOHN M. MCLAIN
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Credential | LMFT
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Telephone | 770-452-9995
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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 |
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License Number State |
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