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243 S Culver St Lawrenceville GA 30046-4805 | |
| (678) 313-4493 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 243 S Culver St, Lawrenceville, Georgia |
| Authorized Official Name and Position | Joy S. Mock (OWNER) |
| Authorized Official Contact | 6783134493 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1580 Peachcrest Dr Lawrenceville GA 30043-2873 Ph: (678) 313-4493 | 243 S Culver St Lawrenceville GA 30046-4805 Ph: (678) 313-4493 |
| NPI Number | 1518598457 |
|---|---|
| Provider Enumeration Date | 01/29/2020 |
| Last Update Date | 09/18/2020 |
| Certification Date | 09/09/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518598457 | NPI | - | NPPES |
| 006600 | Other | GA | LPC LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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