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General NPI Number Information
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NPI Number | 1982946828
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Entity Type | Organization
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Legal Business Name | OPEN ARMS COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 2801 BUFORD HWY NE T-10
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City | ATLANTA
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State | GA
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Zip | 30329-2149
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Country | US
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Telephone | 404-645-0550
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 190495
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City | ATLANTA
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State | GA
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Zip | 31119-0495
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Country | US
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Telephone | 404-645-0550
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | SHAKETA ROBINSON-BRUCE
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Credential | LPC
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Telephone | 404-645-0550
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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 | LPC005567
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License Number State | GA
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