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General NPI Number Information
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NPI Number | 1588253280
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Entity Type | Organization
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Legal Business Name | BOUNDLESS LOVE PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 01/16/2021
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Last Update Date | 12/25/2024
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Provider Practice Location Address
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Address Line | 34 STEEPLE CHASE TRL
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City | DALLAS
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State | GA
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Zip | 30132-8305
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Country | US
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Telephone | 470-985-6858
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Fax | 678-669-1898
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Provider Business Mailing Address
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Address Line | 34 STEEPLE CHASE TRL
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City | DALLAS
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State | GA
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Zip | 30132-8305
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Country | US
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Telephone | 470-985-6858
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Fax | 678-669-1898
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | MRS. SUZETTE DELICIA WILLIAMS
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Credential | LPC
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Telephone | 678-250-6026
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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