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General NPI Number Information
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NPI Number | 1871380360
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Entity Type | Organization
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Legal Business Name | ESP WELLNESS TRAINING AND SUPERVISION INC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 14 EASTBROOK BND STE 218
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1521
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Country | US
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Telephone | 706-873-1234
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Fax | 833-564-9014
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Provider Business Mailing Address
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Address Line | 14 EASTBROOK BND STE 218
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1521
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Country | US
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Telephone | 706-873-1234
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Fax | 833-564-9014
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | LAURYN OVERSTREET
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Credential | LCSW
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Telephone | 443-477-7213
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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