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General NPI Number Information
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NPI Number | 1528366101
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Entity Type | Organization
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Legal Business Name | SMALLS THERAPEUTIC COUNSELING CENTER
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Dates
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Enumeration Date | 03/07/2011
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 1195 FAIRVIEW RD
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-1144
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Country | US
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Telephone | 404-328-6685
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 71
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City | ELLENWOOD
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State | GA
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Zip | 30294-0071
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Country | US
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Telephone | 404-328-6685
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | TRACY NICOLE SMALLS
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Credential | MA
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Telephone | 404-328-6685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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