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General NPI Number Information
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NPI Number | 1477918266
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Entity Type | Organization
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Legal Business Name | PEACE OF MIND COUNSELING, LLC
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Dates
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Enumeration Date | 12/21/2015
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 8306 OFFICE PARK DR STE C
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6935
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Country | US
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Telephone | 470-331-1573
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Fax | 770-995-1959
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Provider Business Mailing Address
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Address Line | 2440 MCCALL CT
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-3093
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Country | US
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Telephone | 470-331-1573
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Fax | 770-995-1959
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Authorized Official
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Title or Position | OWNER
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Name | TRACEY SIMPSON
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Credential | LPC
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Telephone | 470-331-1573
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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 | LPC003685
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License Number State | GA
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