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General NPI Number Information
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NPI Number | 1700108941
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Entity Type | Organization
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Legal Business Name | PERSONAL COACHING & PSYCHOTHERAPY ASSOCIATES, LLC
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Dates
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Enumeration Date | 02/15/2010
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Last Update Date | 02/15/2010
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Provider Practice Location Address
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Address Line | 175 PINE GROVE RD SUITE 125
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City | CARTERSVILLE
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State | GA
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Zip | 30120-8483
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Country | US
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Telephone | 678-230-8127
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Fax |
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Provider Business Mailing Address
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Address Line | 175 PINE GROVE RD SUITE 125
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City | CARTERSVILLE
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State | GA
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Zip | 30120-8483
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Country | US
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Telephone | 678-230-8127
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND DIRECTOR
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Name | PAMELA H BARGE
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Credential | M.S., LPC, NCC, DCC
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Telephone | 678-230-8127
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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 | 005264
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License Number State | GA
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