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General NPI Number Information
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NPI Number | 1770716268
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Entity Type | Organization
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Legal Business Name | CHOCOLATE HEALING ARTS CENTER
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 4006 MUNDY MILL RD
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City | OAKWOOD
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State | GA
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Zip | 30566-2807
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Country | US
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Telephone | 770-532-3178
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6842
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City | GAINESVILLE
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State | GA
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Zip | 30504-1088
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Country | US
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Telephone | 770-532-3178
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | MS. CYNTHIA PURCELL
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Credential | L.P.C.
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Telephone | 770-532-3178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC004338
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License Number State | GA
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