Source of Strength Professional Counseling, PC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LPC006099 Issued in GA

Legal business name

SOURCE OF STRENGTH PROFESSIONAL COUNSELING, PC

Practice address

821 Pavilion CT
Suite a
McDonough, GA 30253-5222

Phone

(404) 272-3436

Fax

(404) 855-2887

NPI assigned

Aug 11, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Latrina Graham, LPC, NCCNPI 1598809469

Title

Owner/Ceo

Phone

(404) 272-3436

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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

• Latrina Graham, LPC

  • Professional Counselor
  • McDonough, GA
  • NPI 1598809469
  NPD (past) Authorized official

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

{
    "created_epoch": "1376179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379203200000",
    "number": "1407289721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2890 HIGHWAY 212 SW",
            "address_2": "SUITE A-289",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300943363",
            "telephone_number": "404-272-3436",
            "fax_number": "404-855-2887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 PAVILION CT",
            "address_2": "SUITE A",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302535222",
            "telephone_number": "404-272-3436",
            "fax_number": "404-855-2887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCE OF STRENGTH PROFESSIONAL COUNSELING, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-11",
        "last_updated": "2013-09-15",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "LATRINA",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "404-272-3436",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC, NCC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "LPC006099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003133448A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003133452A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in McDonough, GA
• Providers in McDonough, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.