Individual
EDEN PARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, LPC
Contact information
Practice address
21 CRESCENT CHASE, DALLAS, GA 30157-5729
(404) 399-7480
Mailing address
21 CRESCENT CHASE, DALLAS, GA 30157-5729
(404) 399-7480
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LPC008454
GA
163W00000X
Registered Nurse
Primary
RN309891
GA
Other
Enumeration date
01/25/2016
Last updated
06/10/2022
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