=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730224874
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHELTERED COVE COUNSELING CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6488 SPRING ST STE 102
-----------------------------------------------------
City | DOUGLASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30134-1895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-949-1595
-----------------------------------------------------
Fax | 770-489-7521
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6488 SPRING ST STE 102
-----------------------------------------------------
City | DOUGLASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30134-1895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-949-1595
-----------------------------------------------------
Fax | 770-489-7521
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER THERAPIST
-----------------------------------------------------
Name | LISA RENE KLINGER
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 770-949-1595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------