1932628518 NPI number — RESTORING WELLNESS COUNSELING

Table of content: LINDSAY CLARK ROSE MS, LCMHCA (NPI 1578356176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932628518 NPI number — RESTORING WELLNESS COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESTORING WELLNESS COUNSELING
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:
1932628518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1623 CHERRY HILL CT SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONYERS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30094-6273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-568-9089
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1226 ROYAL DR SW STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONYERS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30094-5926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-568-9089
Provider Business Practice Location Address Fax Number:
770-568-9089
Provider Enumeration Date:
09/14/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
ROSE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
770-568-9089

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CSW005212 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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