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General NPI Number Information
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NPI Number | 1760927503
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Entity Type | Organization
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Legal Business Name | ALPHARETTA/JOHNS CREEK COUNSELING FOR CHILDREN AND ADULTS
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 400 PROSPECT PL
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City | ALPHARETTA
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State | GA
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Zip | 30005-5468
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Country | US
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Telephone | 404-834-2363
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Fax | 866-422-4042
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Provider Business Mailing Address
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Address Line | 400 PROSPECT PL
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City | ALPHARETTA
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State | GA
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Zip | 30005-5468
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Country | US
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Telephone | 404-834-2363
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Fax | 866-422-4042
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | MRS. ERICA ANN GREGORY
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Credential | LMFT
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Telephone | 404-834-2363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 101YA0400X
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 101Y00000X
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC008501
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT001278
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License Number State | GA
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