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General NPI Number Information
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NPI Number | 1407197890
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Entity Type | Organization
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Legal Business Name | OUT LOUD COUNSELING
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Dates
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Enumeration Date | 03/08/2013
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Last Update Date | 03/08/2013
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Provider Practice Location Address
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Address Line | 2801 BUFORD HWY NE SUITE T-60
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City | ATLANTA
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State | GA
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Zip | 30329-2149
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Country | US
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Telephone | 678-568-9725
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Fax |
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Provider Business Mailing Address
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Address Line | 1956 VANCE DR NE
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City | ATLANTA
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State | GA
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Zip | 30345-3016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO AND THERAPIST
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Name | MELANIE STORRUSTEN
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Credential | LCSW
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Telephone | 678-568-9725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004317
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License Number State | GA
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