11D2214478 CLIA NUMBER - EXPANSION COUNSELING SERVICES, LLC

Laboratory Demographics

  • CLIA Code: 11D2214478
  • Facility Name: EXPANSION COUNSELING SERVICES, LLC
  • Facility Address: 500 SUN VALLEY DRIVE SUITE D2
    ROSWELL, GA
    ZIP 30076
  • Facility Phone: 770 910-9162
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: EBONI R. MORMANT
  • NPI Number: 1720539562
  • Taxonomy: 101YP2500X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 11D2214478
LAB Type Practitioner Other
Facility Name EXPANSION COUNSELING SERVICES, LLC
Street 500 SUN VALLEY DRIVE SUITE D2
City ROSWELL
State GA
ZIP 30076
Phone 770 910-9162
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/23/2025
Certificate Expiration Date 2/22/2027
Facility Type Practitioner Other
Lab Director EBONI R. MORMANT

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This page was last updated on: 9/29/2025