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General NPI Number Information
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NPI Number | 1497387963
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Entity Type | Organization
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Legal Business Name | DIAMOND COUNSELING AND COACHING, LLC
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 135 BRADFORD SQ STE B
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-1902
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Country | US
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Telephone | 678-886-9112
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Fax | 404-900-9088
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Provider Business Mailing Address
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Address Line | 11658 KADES TRL
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City | HAMPTON
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State | GA
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Zip | 30228-4012
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Country | US
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Telephone | 678-886-9112
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Fax | 404-900-9088
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Authorized Official
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Title or Position | LICENSE PROFESSIONAL COUNSELOR
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Name | MRS. ROSELANDE DOMOND
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Credential | LPC
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Telephone | 678-886-9112
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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 |
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License Number State |
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