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General NPI Number Information
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NPI Number | 1588103956
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Entity Type | Organization
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Legal Business Name | SBG COUNSELING, INC
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Dates
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Enumeration Date | 02/18/2017
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Last Update Date | 02/18/2017
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Provider Practice Location Address
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Address Line | 980 SAINT CHARLES AVE NE #3
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City | ATLANTA
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State | GA
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Zip | 30306-4263
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Country | US
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Telephone | 954-895-1453
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Fax |
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Provider Business Mailing Address
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Address Line | 980 SAINT CHARLES AVE NE #3
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City | ATLANTA
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State | GA
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Zip | 30306-4263
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Country | US
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Telephone | 954-895-1453
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | SHAINA GORDON
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Credential |
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Telephone | 954-895-1453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CSW005234
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License Number State | GA
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