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General NPI Number Information
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NPI Number | 1669678413
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Entity Type | Organization
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Legal Business Name | SACRED MOUNTAIN PARTNERS, LLC
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 340 PINE CREST RD
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City | JASPER
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State | GA
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Zip | 30143-2662
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Country | US
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Telephone | 404-808-7740
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Fax |
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Provider Business Mailing Address
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Address Line | 340 PINE CREST RD
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City | JASPER
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State | GA
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Zip | 30143-2662
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Country | US
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Telephone | 404-808-7740
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MELANIE ANN DALLAS
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Credential | LPC
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Telephone | 706-692-0131
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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 | 003408
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License Number State | GA
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