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General NPI Number Information
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NPI Number | 1821381187
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Entity Type | Organization
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Legal Business Name | IMPACTINGPEOPLE, LLC
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Dates
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Enumeration Date | 05/19/2011
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | 1741 HOG MOUNTAIN RD
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City | WATKINSVILLE
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State | GA
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Zip | 30677-1947
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Country | US
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Telephone | 706-714-6115
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Fax |
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Provider Business Mailing Address
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Address Line | 2728 POWELL CT
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City | MONROE
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State | GA
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Zip | 30656-8675
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Country | US
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Telephone | 706-714-6115
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Fax |
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Authorized Official
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Title or Position | OWNER/PROFESSIONAL COUNSELOR
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Name | DR. DAVID WILLIAM ANDERSON
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Credential | PH.D., L.P.C.
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Telephone | 706-714-6115
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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 | LPC003011
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License Number State | GA
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