MEDICARE: BEGIN AGAIN COUNSELING COACHING & CONSULTANT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YP1600X	Pastoral Counselor
3	101YP2500X	Professional Counselor
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1780271718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEGIN AGAIN COUNSELING COACHING & CONSULTANT SERVICES LLC

Provider Business Mailing Address
First Line	:	4190 PEACE ROSE PL
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-5112
Country	:	US
Telephone Number	:	678-640-3196
Fax Number	:

Provider Business Practice Location Address
First Line	:	4190 PEACE ROSE PL
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-5112
Country	:	US
Telephone Number	:	678-640-3196
Fax Number	:

Authorized Official
Title or Position	:	OWNER, LPC
Name	:	ERICA GERALDS
Credential	:	MDIV, MS, LPC
Telephone Number	:	678-640-3196

Provider Enumeration Date	:	12/23/2020
Last Update Date	:	12/23/2020

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