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General NPI Number Information
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NPI Number | 1891462826
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Entity Type | Individual
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Provider Name | CHRISTOPHER CLEARY
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Gender | Male
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 01/17/2026
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Provider Practice Location Address
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Address Line | 675 MANSELL RD
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City | ROSWELL
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State | GA
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Zip | 30076-4863
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Country | US
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Telephone | 706-581-8132
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Fax |
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Provider Business Mailing Address
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Address Line | 104 PILGRIM VILLAGE DR STE 300
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City | CUMMING
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State | GA
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Zip | 30040-9232
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Country | US
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Telephone | 706-581-8132
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | GA
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