Unleashed Potential Counseling and Services, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

UNLEASHED POTENTIAL COUNSELING AND SERVICES, LLC

Practice address

4729 Quaker Rd
Administration Suite
Keysville, GA 30816-4950

Phone

(706) 836-7873

Fax

(706) 595-3070

NPI assigned

Mar 23, 2017

Organization subpart

No

Name

Audrey Mack, LPC

Title

Executive Director

Phone

(706) 394-4357

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 23, 2017.

{
    "created_epoch": "1490227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490227200000",
    "number": "1922539709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4729 QUAKER RD",
            "address_2": "ADMINISTRATION SUITE",
            "city": "KEYSVILLE",
            "state": "GA",
            "postal_code": "308164950",
            "telephone_number": "706-836-7873",
            "fax_number": "706-595-3070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4729 QUAKER RD",
            "address_2": "ADMINISTRATION SUITE",
            "city": "KEYSVILLE",
            "state": "GA",
            "postal_code": "308164950",
            "telephone_number": "706-836-7873",
            "fax_number": "706-595-3070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNLEASHED POTENTIAL COUNSELING AND SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-23",
        "last_updated": "2017-03-23",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "706-394-4357",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Keysville, GA
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2017; 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.