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General NPI Number Information
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NPI Number | 1558528828
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Entity Type | Organization
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Legal Business Name | MARIETTA WEST COBB COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 707 WHITLOCK AVE SW STE H10
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City | MARIETTA
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State | GA
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Zip | 30064-3098
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Country | US
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Telephone | 770-415-0880
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Fax |
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Provider Business Mailing Address
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Address Line | 707 WHITLOCK AVE SW SUITE H-10
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City | MARIETTA
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State | GA
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Zip | 30064-3000
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Country | US
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Telephone | 770-591-7518
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Fax | 678-498-2843
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Authorized Official
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Title or Position | CEO
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Name | MS. TERRI ABRAHAM
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Credential | LPC
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Telephone | 770-591-7518
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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 | 003709
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License Number State | GA
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