Fountain Gate Life and Wellness, Inc.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

FOUNTAIN GATE LIFE AND WELLNESS, INC.

Doing business as

Fountain Gate Counseling Center

Practice address

2985 Cherokee St NW
Kennesaw, GA 30144-2863

Phone

(770) 218-9005

Fax

(770) 485-8481

NPI assigned

Sep 13, 2011

Organization subpart

No

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

Authorized official

Name

Craig Torell, M.A., M.DIV., LPC

Title

Executive Director

Phone

(770) 218-9005

Specialties & licenses 3

Addresses

Other names 1

• Fountain Gate Counseling Center Doing business as

Locations

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

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446508800000",
    "number": "1780966051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2985 CHEROKEE ST NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301442863",
            "telephone_number": "770-218-9005",
            "fax_number": "770-485-8481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2985 CHEROKEE ST NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301442863",
            "telephone_number": "770-218-9005",
            "fax_number": "770-485-8481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN GATE LIFE AND WELLNESS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-13",
        "last_updated": "2015-11-03",
        "status": "A",
        "authorized_official_last_name": "TORELL",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "770-218-9005",
        "authorized_official_credential": "M.A., M.DIV., LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fountain Gate Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mark Fouts
• Amy Fowler, PAAA
• Angela Marie Stephens Fowler
• Simon Charles Fowler, PTA
• Chelsey Fowlkes

• Professional Counselor in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2015; 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.