=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386580702
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MADE NEW COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2026
-----------------------------------------------------
Last Update Date | 04/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2180 ELM ST NE
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30014-2429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-308-4511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2180 ELM ST NE
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30014-2429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-308-4511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHARMION LETITIA ROBERTS
-----------------------------------------------------
Credential | LPC, NCC
-----------------------------------------------------
Telephone | 478-308-4511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------