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NPI Code Detail

MEDICARE: UNITED BRANCHES FOUNDATION LTD

MEDICARE: UNITED BRANCHES FOUNDATION LTD
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLPC004526GA

General Provider Information

NPI Number : 1790144988
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNITED BRANCHES FOUNDATION LTD
Provider Business Mailing Address
First Line : 950 EAGLES LANDING PKWY
Second Line : 257
City : STOCKBRIDGE
State : GA
Zip : 30281
Country : US
Telephone Number : 404-769-8771
Fax Number : 844-733-1154
Provider Business Practice Location Address
First Line : 245 COUNTRY CLUB DR
Second Line : 200H
City : STOCKBRIDGE
State : GA
Zip : 30281-9080
Country : US
Telephone Number : 678-435-9132
Fax Number : 844-733-1154
Authorized Official
Title or Position : CEO
Name : KECIA WEST
Credential : LPC
Telephone Number : 678-435-9132
Provider Enumeration Date : 02/16/2016
Last Update Date : 02/16/2016

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Directions to “UNITED BRANCHES FOUNDATION LTD ” Practice Location

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