=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518598457
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENUINE JOY COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2020
-----------------------------------------------------
Last Update Date | 09/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 243 S CULVER ST
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30046-4805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-313-4493
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1580 PEACHCREST DR
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30043-2873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-313-4493
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOY S. MOCK
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 678-313-4493
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------