Provider Demographics
NPI:1205563384
Name:NORTHWEST COUNSELING PROFESSIONALS
Entity type:Organization
Organization Name:NORTHWEST COUNSELING PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, NCC, CACII
Authorized Official - Phone:678-365-7243
Mailing Address - Street 1:5604 WENDY BAGWELL PKWY STE 811
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-7819
Mailing Address - Country:US
Mailing Address - Phone:678-720-2119
Mailing Address - Fax:678-730-7242
Practice Address - Street 1:5604 WENDY BAGWELL PKWY STE 811
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-7819
Practice Address - Country:US
Practice Address - Phone:678-720-2119
Practice Address - Fax:678-730-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC04621OtherLICENSE NUMBER