| Quinnise Pettway, Lpc, Ncc | |
|
490 Sun Valley Dr Suite 205 Roswell GA 30076-5615 | |
| (770) 642-4236 | |
| Not Available |
| Full Name | Quinnise Pettway, Lpc, Ncc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 490 Sun Valley Dr, Roswell, Georgia |
| Authorized Official Name and Position | Quinnise Pettway (OWNER/PRESIDENT) |
| Authorized Official Contact | 7706424236 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Quinnise Pettway, Lpc, Ncc 490 Sun Valley Dr Suite 205 Roswell GA 30076-5615 Ph: (770) 642-4236 | Quinnise Pettway, Lpc, Ncc 490 Sun Valley Dr Suite 205 Roswell GA 30076-5615 Ph: (770) 642-4236 |
| NPI Number | 1144512591 |
|---|---|
| Provider Enumeration Date | 05/04/2011 |
| Last Update Date | 05/04/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144512591 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC006121 (Georgia) | Primary |
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