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34 Steeple Chase Trl Dallas GA 30132-8305 | |
| (470) 985-6858 | |
| (678) 669-1898 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 34 Steeple Chase Trl, Dallas, Georgia |
| Authorized Official Name and Position | Suzette Delicia Williams (PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 6782506026 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
34 Steeple Chase Trl Dallas GA 30132-8305 Ph: (470) 985-6858 | 34 Steeple Chase Trl Dallas GA 30132-8305 Ph: (470) 985-6858 |
| NPI Number | 1588253280 |
|---|---|
| Provider Enumeration Date | 01/16/2021 |
| Last Update Date | 12/25/2024 |
| Certification Date | 12/25/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588253280 | NPI | - | NPPES |
| 011523 | Other | GA | LPC |
| 1942823901 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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