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General NPI Number Information
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NPI Number | 1427256866
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Entity Type | Organization
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Legal Business Name | FOOTHILLS COUNSELING ASSOCIATES INC.
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Dates
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Enumeration Date | 07/06/2007
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 105 VILLAGE WALK 180 C
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City | DALLAS
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State | GA
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Zip | 30132-5504
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Country | US
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Telephone | 770-826-5542
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Fax | 866-840-0590
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Provider Business Mailing Address
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Address Line | 105 VILLAGE WALK 180C
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City | DALLAS
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State | GA
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Zip | 30132-5504
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Country | US
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Telephone | 770-826-5542
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Fax | 866-840-0590
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Authorized Official
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Title or Position | SECRETARY
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Name | MYKE MCCORMICK
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Credential |
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Telephone | 770-826-5542
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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 | LPC003940
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License Number State | GA
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