=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619416575
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEXT STEP COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2017
-----------------------------------------------------
Last Update Date | 02/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 HABERSHAM DR SUITE 142
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30214-1381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-371-5057
-----------------------------------------------------
Fax | 404-537-1045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 HABERSHAM DR SUITE 142
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30214-1381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-371-5057
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KEISHA LATONYA POU
-----------------------------------------------------
Credential | EDD
-----------------------------------------------------
Telephone | 770-371-5057
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 5425
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------