Individual
MR. GREGORY DAQUAN COUSAR-ROPER I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
JUNIOR COUNSELOR,CAS
Contact information
Practice address
6482 KLINECT CT, B, NORCROSS, GA 30092-7111
(678) 558-7078
Mailing address
6482 KLINECT CT, B, NORCROSS, GA 30092-7111
(678) 558-7078
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
EN799987
GA
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T0086
GA
1041C0700X
Clinical Social Worker
153504907886
GA
Other
Enumeration date
04/20/2016
Last updated
04/20/2016
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