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General NPI Number Information
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NPI Number | 1386196871
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Entity Type | Organization
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Legal Business Name | RANDALL OVERDORFF, LPC
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Dates
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Enumeration Date | 10/31/2016
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Last Update Date | 11/11/2016
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Provider Practice Location Address
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Address Line | 629 DAWSONVILLE HWY STE 2201
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City | GAINESVILLE
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State | GA
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Zip | 30501-2610
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Country | US
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Telephone | 678-936-4954
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Fax | 770-534-9104
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Provider Business Mailing Address
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Address Line | 2038 PINE TREE CIR
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City | GAINESVILLE
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State | GA
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Zip | 30501-1334
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Country | US
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Telephone | 678-936-4954
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Fax | 770-534-9104
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Authorized Official
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Title or Position | OWNER
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Name | RANDY OVERDORFF
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Credential | LPC
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Telephone | 770-339-7667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC001347
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License Number State | GA
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