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General NPI Number Information
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NPI Number | 1447600853
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Entity Type | Organization
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Legal Business Name | GREATER ROME PSYCHOTHERAPY SERVICES LLC
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 2501 CALLIER SPRINGS RD SE
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City | ROME
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State | GA
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Zip | 30161-6605
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Country | US
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Telephone | 256-572-6924
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Fax | 706-295-2267
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Provider Business Mailing Address
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Address Line | 19 ROSEWOOD RD SW
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City | ROME
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State | GA
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Zip | 30165-4227
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Country | US
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Telephone | 256-572-6924
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Fax | 706-295-2267
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | SCOTT D MCDANIEL
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Credential | LPC
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Telephone | 256-572-6924
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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 | 004274
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License Number State | GA
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