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General NPI Number Information
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NPI Number | 1831626829
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Entity Type | Organization
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Legal Business Name | ECUMENICAL CHRISTIAN WELLNESS MINISTRIES
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 05/22/2017
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Provider Practice Location Address
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Address Line | 2276 HIGHWAY 17 STE E
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City | SAUTEE
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State | GA
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Zip | 30571-3035
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Country | US
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Telephone | 678-358-8775
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 262
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City | SAUTEE
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State | GA
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Zip | 30571-0262
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Country | US
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Telephone | 678-358-8775
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. DAVID J MILLER
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Credential | LPC
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Telephone | 678-358-8775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC008369
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License Number State | GA
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