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General NPI Number Information
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NPI Number | 1508483389
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Entity Type | Organization
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Legal Business Name | TRANSFORM YOU LLC
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 130 HOWELL RD STE D
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City | TYRONE
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State | GA
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Zip | 30290-2097
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Country | US
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Telephone | 404-451-1631
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Fax |
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Provider Business Mailing Address
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Address Line | 595 OLD GREENVILLE RD
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-5930
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Country | US
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Telephone | 404-451-1631
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | OLIVIA C FRAZIER
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Credential | LPC
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Telephone | 404-451-1631
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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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