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General NPI Number Information
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NPI Number | 1538557053
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Entity Type | Organization
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Legal Business Name | FORSYTH FAMILY COUNSELING LLC
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 102 MARY ALICE PARK RD STE 306
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City | CUMMING
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State | GA
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Zip | 30040-2690
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Country | US
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Telephone | 404-548-8557
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Fax |
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Provider Business Mailing Address
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Address Line | 102 MARY ALICE PARK RD STE 306
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City | CUMMING
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State | GA
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Zip | 30040-2690
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Country | US
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Telephone | 404-548-8557
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. JAMIE M BRAY
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Credential | LCSW
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Telephone | 404-548-8557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 01364
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License Number State | GA
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