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General NPI Number Information
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NPI Number | 1952640302
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Entity Type | Organization
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Legal Business Name | COUNSELING, HYPNOTHERAPY, AND LIFE COACHING SERVICES OF HIRAM
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 02/05/2013
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Provider Practice Location Address
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Address Line | 44 DARBY'S CROSSING DRIVE SUITE 206H
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City | HIRAM
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State | GA
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Zip | 30141-6029
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Country | US
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Telephone | 678-978-0464
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Fax | 678-715-8796
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Provider Business Mailing Address
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Address Line | 44 DARBY'S CROSSING DRIVE SUITE 206H
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City | HIRAM
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State | GA
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Zip | 30141-6029
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Country | US
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Telephone | 678-978-0464
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Fax | 678-715-8796
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Authorized Official
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Title or Position | OWNER/LIC. PROF. COUNSELOR
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Name | MS. CHRISTINE JANE MEZZA
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Credential | LPC
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Telephone | 678-978-0464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 004731
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 004731
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License Number State | GA
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