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General NPI Number Information
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NPI Number | 1871726695
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Entity Type | Organization
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Legal Business Name | CHESTATEE COUNSELING CENTER
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 487 MORRISON MOORE PKWY W
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City | DAHLONEGA
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State | GA
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Zip | 30533-1422
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Country | US
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Telephone | 404-386-1090
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Fax | 678-455-0682
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Provider Business Mailing Address
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Address Line | PO BOX 708
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City | DAHLONEGA
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State | GA
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Zip | 30533-0012
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Country | US
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Telephone | 404-386-1090
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Fax | 678-455-0682
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. STACY WOLFF
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Credential | LCSW
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Telephone | 404-386-1090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW002651
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License Number State | GA
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