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General NPI Number Information
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NPI Number | 1518290857
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Entity Type | Organization
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Legal Business Name | ACCORDIA COUNSELING SOLUTIONS
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Dates
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Enumeration Date | 09/17/2009
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Last Update Date | 09/17/2009
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Provider Practice Location Address
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Address Line | 115 HABERSHAM DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7353
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Country | US
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Telephone | 770-461-9944
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Fax | 770-461-9779
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Provider Business Mailing Address
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Address Line | 115 HABERSHAM DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7353
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Country | US
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Telephone | 770-461-9944
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Fax | 770-461-9779
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY AYCOCK
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Credential | PH.D.
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Telephone | 770-461-9944
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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 | LPC002250
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW000340
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY001928
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License Number State | GA
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