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General NPI Number Information
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NPI Number | 1497140735
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Entity Type | Organization
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Legal Business Name | CRYSTAL CLEAR CONSULTATIONS, INC.
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Dates
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Enumeration Date | 04/03/2015
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Last Update Date | 04/03/2015
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Provider Practice Location Address
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Address Line | 34 ATLANTA AVE SE
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City | ATLANTA
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State | GA
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Zip | 30315-1804
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Country | US
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Telephone | 770-906-8471
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Fax |
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Provider Business Mailing Address
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Address Line | 444 HIGHLAND AVE NE STE 329
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City | ATLANTA
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State | GA
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Zip | 30312-1301
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Country | US
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Telephone | 404-720-0877
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Fax | 404-720-0877
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MS. SULONDA SMITH
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Credential | LPC
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Telephone | 404-720-0877
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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 | LPC006644
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License Number State | GA
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