1396484812 NPI number — NORTH FULTON COUNSELING PSYCHOTHERAPY AND CONSULTING

Table of content: (NPI 1396484812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396484812 NPI number — NORTH FULTON COUNSELING PSYCHOTHERAPY AND CONSULTING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH FULTON COUNSELING PSYCHOTHERAPY AND CONSULTING
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:
1396484812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3211 CANYON POINT CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30076-5109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-469-1296
Provider Business Mailing Address Fax Number:
404-365-3859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11285 EKINS ROAD SUITE
Provider Second Line Business Practice Location Address:
SUITE D-2
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076-3007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-772-8884
Provider Business Practice Location Address Fax Number:
404-365-3859
Provider Enumeration Date:
06/02/2022

Additional Information

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
DIRECTOR/THERAPIST
Authorized Official Telephone Number:
678-469-1296

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1205106085 . This is a "NON MEDICAID PROVIDER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1821478264 . This is a "NON MEDICARE MENTAL HEALTH PROVIDER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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