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General NPI Number Information
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NPI Number | 1447078548
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Entity Type | Organization
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Legal Business Name | FORTITUDE2GROW COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 09/28/2024
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Last Update Date | 09/28/2024
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Provider Practice Location Address
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Address Line | 170 BROOKSTONE CRST
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City | NEWNAN
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State | GA
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Zip | 30265-2270
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Country | US
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Telephone | 678-877-1730
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Fax |
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Provider Business Mailing Address
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Address Line | 90F GLENDA TRCE STE 236
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City | NEWNAN
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State | GA
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Zip | 30265-3858
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Country | US
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Telephone | 678-877-1730
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WAIKIKI L UPSHAW
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Credential | EDD, LPC, CPCS
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Telephone | 678-877-1395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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