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General NPI Number Information
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NPI Number | 1669068458
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Entity Type | Organization
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Legal Business Name | MENDED MATTERS COUNSELING
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 1760 LAKES PKWY UNIT 4204
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-6072
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Country | US
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Telephone | 716-292-5661
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Fax |
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Provider Business Mailing Address
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Address Line | 4850 SUGARLOAF PKWY STE 209-317
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2859
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | ANDREA NICOLE YOUNGER
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Credential | LPC
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Telephone | 404-857-4531
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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 |
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License Number State |
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