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General NPI Number Information
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NPI Number | 1932447950
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Entity Type | Organization
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Legal Business Name | MICHAEL-RENEE GODFREY, RN, LPC, PC
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Dates
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Enumeration Date | 01/25/2013
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 2453 POWDER SPRINGS RD SW SUITE 320
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City | MARIETTA
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State | GA
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Zip | 30064-4570
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Country | US
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Telephone | 678-401-8106
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Fax | 678-398-9065
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Provider Business Mailing Address
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Address Line | 2453 POWDER SPRINGS RD SW SUITE 320
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City | MARIETTA
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State | GA
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Zip | 30064-4570
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Country | US
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Telephone | 678-401-8106
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Fax | 678-398-9065
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Authorized Official
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Title or Position | CEO
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Name | MS. MICHAEL-RENEE GODFREY
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Credential | RN, LPC, DCC
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Telephone | 678-401-8106
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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 | 6036
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License Number State | GA
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