Provider Demographics
NPI:1952640302
Name:COUNSELING, HYPNOTHERAPY, AND LIFE COACHING SERVICES OF HIRAM
Entity Type:Organization
Organization Name:COUNSELING, HYPNOTHERAPY, AND LIFE COACHING SERVICES OF HIRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LIC. PROF. COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MEZZA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-978-0464
Mailing Address - Street 1:44 DARBY'S CROSSING DRIVE
Mailing Address - Street 2:SUITE 206H
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-6029
Mailing Address - Country:US
Mailing Address - Phone:678-978-0464
Mailing Address - Fax:678-715-8796
Practice Address - Street 1:44 DARBY'S CROSSING DRIVE
Practice Address - Street 2:SUITE 206H
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-6029
Practice Address - Country:US
Practice Address - Phone:678-978-0464
Practice Address - Fax:678-715-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004731261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health