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General NPI Number Information
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NPI Number | 1659393874
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Entity Type | Individual
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Provider Name | SARA HINES MARTIN M.S. COUNSELOR
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Gender | Female
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2365 HIGHWAY 92 STE 100
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City | ACWORTH
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State | GA
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Zip | 30102-7712
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Country | US
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Telephone | 770-975-7980
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Fax | 770-974-0350
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Provider Business Mailing Address
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Address Line | 4946 HOLBORN WAY
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City | ACWORTH
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State | GA
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Zip | 30101-4883
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Country | US
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Telephone | 770-975-7980
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Fax | 770-974-0350
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LPCA 1473
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License Number State | GA
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