=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881979433
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PINNACLE THERAPY & COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2011
-----------------------------------------------------
Last Update Date | 10/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 ROCK QUARRY RD # 723
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-4467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-920-3876
-----------------------------------------------------
Fax | 678-625-6079
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2153
-----------------------------------------------------
City | LITHONIA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30058-1046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-920-3876
-----------------------------------------------------
Fax | 678-625-6079
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | GLENDA L CORDY
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 678-920-3876
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | LPC004313
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------