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General NPI Number Information
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NPI Number | 1912284084
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Entity Type | Organization
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Legal Business Name | WELLSPRING COUNSELING NORTH GEORGIA LLC
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Dates
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Enumeration Date | 11/03/2011
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 800 OLD DAWSON VILLAGE RD E STE 010
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City | DAWSONVILLE
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State | GA
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Zip | 30534-3816
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Country | US
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Telephone | 866-714-1224
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Fax | 866-718-3108
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Provider Business Mailing Address
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Address Line | 800 OLD DAWSON VILLAGE RD E STE 010
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City | DAWSONVILLE
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State | GA
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Zip | 30534-3816
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHY R DODSON
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Credential | MS
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Telephone | 866-714-1224
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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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