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General NPI Number Information
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NPI Number | 1366259558
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Entity Type | Individual
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Provider Name | NATALIE S JANUSCZOK AMFT
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Gender | Female
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 327 DAHLONEGA ST STE A601
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City | CUMMING
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State | GA
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Zip | 30040-2488
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Country | US
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Telephone | 678-661-1508
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Fax |
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Provider Business Mailing Address
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Address Line | 6205 NOBLE VINES DR # 6205
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City | BUFORD
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State | GA
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Zip | 30519-6139
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Country | US
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Telephone | 415-697-4409
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MFTC.0014748
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License Number State | CO
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