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230 S Culver St Lawrenceville GA 30046-4806 | |
| (678) 883-8609 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 230 S Culver St, Lawrenceville, Georgia |
| Authorized Official Name and Position | Terro L White (OWNER) |
| Authorized Official Contact | 6788838609 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3932 Plymouth Rock Dr Loganville GA 30052-8712 Ph: (678) 883-8609 | 230 S Culver St Lawrenceville GA 30046-4806 Ph: (678) 883-8609 |
| NPI Number | 1093204000 |
|---|---|
| Provider Enumeration Date | 05/04/2018 |
| Last Update Date | 05/04/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093204000 | NPI | - | NPPES |
| 003172353A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC008752 (Georgia) | Primary |
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