A Balanced Place, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

A BALANCED PLACE, LLC

Practice address

4247 Skyline VW
Oakwood, GA 30566-4307

Phone

(678) 387-9076

Fax

(678) 807-2834

NPI assigned

Aug 24, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Charyl Durbin, PH.D LPCNPI 1912313826

Title

Owner

Phone

(678) 387-9076

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charyl Durbin, LPC

  • Professional Counselor
  • Oakwood, GA
  • NPI 1912313826

  GA, Professional

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599004800000",
    "number": "1003429663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4247 SKYLINE VW",
            "city": "OAKWOOD",
            "state": "GA",
            "postal_code": "305664307",
            "telephone_number": "678-387-9076",
            "fax_number": "678-807-2834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4247 SKYLINE VW",
            "city": "OAKWOOD",
            "state": "GA",
            "postal_code": "305664307",
            "telephone_number": "678-387-9076",
            "fax_number": "678-807-2834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A BALANCED PLACE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-24",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-01",
        "status": "A",
        "authorized_official_last_name": "DURBIN",
        "authorized_official_first_name": "CHARYL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-387-9076",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Oakwood, GA
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.