Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC006183 | GA |
NPI | 1003183492 |
---|---|
Provider Name | Teresa Cress |
First Address | Marietta, GA 30064-7518 |
Second Address | Marietta, GA 30064-2597 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2011 |
Last Update Date | 29/11/2011 |