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General NPI Number Information
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NPI Number | 1811486574
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Entity Type | Organization
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Legal Business Name | LAC THERAPY, LLC
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 265 W PIKE ST STE 4
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4896
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Country | US
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Telephone | 404-314-6168
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Fax | 678-407-4444
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Provider Business Mailing Address
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Address Line | 2090A HIGHWAY 317 STE 276
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City | SUWANEE
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State | GA
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Zip | 30024-2623
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Country | US
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Telephone | 404-314-6168
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Fax | 678-407-4444
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Authorized Official
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Title or Position | OWNER
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Name | LAURA COCHLING
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Credential | LPC
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Telephone | 404-314-6168
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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 | LPC005632
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License Number State | GA
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