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General NPI Number Information
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NPI Number | 1376858100
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Entity Type | Organization
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Legal Business Name | GROW HEAL LIVE LEAD LLC
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Dates
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Enumeration Date | 08/17/2010
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 2964 PEACHTREE RD NW SUITE 760
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City | ATLANTA
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State | GA
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Zip | 30305-2153
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Country | US
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Telephone | 678-463-1092
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Fax |
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Provider Business Mailing Address
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Address Line | 2964 PEACHTREE RD NW SUITE 760
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City | ATLANTA
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State | GA
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Zip | 30305-2153
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Country | US
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Telephone | 678-463-1092
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST/PRESIDENT
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Name | DR. WENDY L DICKINSON
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Credential | PH.D.
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Telephone | 678-463-1092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 3256
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License Number State | GA
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