1215114327 NPI number — GWINNETT FAMILY GUIDANCE CENTER

Table of content: (NPI 1215114327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215114327 NPI number — GWINNETT FAMILY GUIDANCE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GWINNETT FAMILY GUIDANCE CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215114327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 562
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORCROSS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30091-0562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-449-0815
Provider Business Mailing Address Fax Number:
770-449-5759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6045 ATLANTIC BLVD.
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
NORCROSS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30071-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-449-0815
Provider Business Practice Location Address Fax Number:
770-449-5759
Provider Enumeration Date:
01/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STEURER
Authorized Official First Name:
LORETTA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
770-449-0815

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  000556LCSW , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 000476LMFT , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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