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General NPI Number Information
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NPI Number | 1982061545
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Entity Type | Organization
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Legal Business Name | SWCCOUNSELING
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 814 MIMOSA BLVD BLDG C
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City | ROSWELL
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State | GA
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Zip | 30075-4410
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Country | US
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Telephone | 678-680-8731
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Fax |
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Provider Business Mailing Address
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Address Line | 4886 CANDLEWOOD LN
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City | STONE MOUNTAIN
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State | GA
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Zip | 30088-1606
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Country | US
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Telephone | 770-469-0124
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VERA HOLLOWAY
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Credential |
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Telephone | 770-469-0124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | LPC008645
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License Number State | GA
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