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General NPI Number Information
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NPI Number | 1750597530
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Entity Type | Organization
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Legal Business Name | CHARTING YOUR COURSE, LLC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 10/07/2010
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Provider Practice Location Address
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Address Line | 1776 CENTURY BLVD NE SUITE A
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City | ATLANTA
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State | GA
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Zip | 30345-3397
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Country | US
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Telephone | 404-579-1987
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Fax | 770-643-3944
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Provider Business Mailing Address
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Address Line | 12 NORCROSS ST SUITE 200C
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City | ROSWELL
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State | GA
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Zip | 30075-7409
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Country | US
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Telephone | 404-579-1987
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Fax | 770-643-3944
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Authorized Official
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Title or Position | OWNER
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Name | DR. HAMID MIRSALIMI
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Credential | PH.D.
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Telephone | 404-579-1987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY002432
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License Number State | GA
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