| |
5425 Sugarloaf Pkwy Ste 1101 Lawrenceville GA 30043-5705 | |
(770) 875-2595 | |
Not Available |
Full Name | |
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Speciality | Counselor |
Location | 5425 Sugarloaf Pkwy Ste 1101, Lawrenceville, Georgia |
Authorized Official Name and Position | Chandra Dew (OWNER) |
Authorized Official Contact | 7708752595 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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5425 Sugarloaf Pkwy Ste 1101 Lawrenceville GA 30043-5705 Ph: (770) 875-2595 | 5425 Sugarloaf Pkwy Ste 1101 Lawrenceville GA 30043-5705 Ph: (770) 875-2595 |
NPI Number | 1477064889 |
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Provider Enumeration Date | 10/12/2017 |
Last Update Date | 11/29/2023 |
Certification Date | 11/29/2023 |
Medicare PECOS PAC ID | 7315399730 |
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Medicare Enrollment ID | O20240122000374 |
Identifier | Type | State | Issuer |
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1477064889 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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101YP2500X | Counselor - Professional | LPC009805 (Georgia) | Primary |
Provider Name | Chandra Dew |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1629588041 PECOS PAC ID: 8224480645 Enrollment ID: I20240122000479 |
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