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General NPI Number Information
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NPI Number | 1619689742
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Entity Type | Organization
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Legal Business Name | ATLANTA CHRISTIAN COUNSELING LLC
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Dates
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Enumeration Date | 12/20/2022
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 15 FISH CAMP ROAD
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City | LAGRANGE
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State | GA
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Zip | 30240
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Country | US
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Telephone | 681-242-7651
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Fax |
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Provider Business Mailing Address
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Address Line | 112 BUENA VISTA DR
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City | LONG BEACH
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State | MS
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Zip | 39560-5703
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Country | US
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Telephone | 681-242-7651
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MARLENA JANETTE PIQUE
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Credential | LCSW
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Telephone | 681-242-7651
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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 |
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License Number State |
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