Basic Information
| Provider Information | |||||||||
| NPI: | 1740687581 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GATHERING PRECIOUS STONES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1718 PEACHTREE ST NW | ||||||||
| Address2: | SUITE 481 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303092452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4049139114 | ||||||||
| FaxNumber: | 4045294729 | ||||||||
| Practice Location | |||||||||
| Address1: | 1718 PEACHTREE ST NW | ||||||||
| Address2: | SUITE 481 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303092452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4049139114 | ||||||||
| FaxNumber: | 4045294729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2014 | ||||||||
| LastUpdateDate: | 11/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | GREEN | ||||||||
| AuthorizedOfficialFirstName: | MICHELE | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4049139114 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC007300 | GA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.