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General NPI Number Information
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NPI Number | 1881088441
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Entity Type | Organization
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Legal Business Name | COUNSELING, PLAY THERAPY & MORE, LLC
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Dates
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Enumeration Date | 03/22/2015
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 2450 ATLANTA HWY SUITE 1903
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City | CUMMING
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State | GA
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Zip | 30040-8099
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Country | US
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Telephone | 678-845-8371
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Fax | 478-202-9022
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Provider Business Mailing Address
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Address Line | 1595 PEACHTREE PKWY STE 204 PMB 138
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City | CUMMING
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State | GA
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Zip | 30041-9584
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Country | US
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Telephone | 770-639-0613
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. RACHELLE TONWAR
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Credential | LPC
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Telephone | 770-639-0613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC004705
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License Number State | GA
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