Provider Demographics
NPI:1962857565
Name:DADDYSGIRL4EVER COUNSELING & COACHING EMPOWERMENT SERVICES INC.
Entity type:Organization
Organization Name:DADDYSGIRL4EVER COUNSELING & COACHING EMPOWERMENT SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANTREIS
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:646-251-6713
Mailing Address - Street 1:1755 N BROWN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-8198
Mailing Address - Country:US
Mailing Address - Phone:678-235-5912
Mailing Address - Fax:404-443-0922
Practice Address - Street 1:1755 N BROWN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-8198
Practice Address - Country:US
Practice Address - Phone:678-235-5912
Practice Address - Fax:404-443-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008467101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497140776OtherINDIVIDUAL NPI
GA003174271AMedicaid
13523914OtherCAQH