MEDICARE: CAPSTONE COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW004487	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114395563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPSTONE COUNSELING LLC

Provider Business Mailing Address
First Line	:	9 DUNWOODY PARK
Second Line	:	SUITE 136
City	:	ATLANTA
State	:	GA
Zip	:	30338-7407
Country	:	US
Telephone Number	:	770-744-5055
Fax Number	:	470-545-4382

Provider Business Practice Location Address
First Line	:	9 DUNWOODY PARK
Second Line	:	SUITE 136
City	:	ATLANTA
State	:	GA
Zip	:	30338-7407
Country	:	US
Telephone Number	:	770-744-5055
Fax Number	:	470-545-4382

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MRS. REVA MANON KRAUS
Credential	:	LCSW
Telephone Number	:	678-727-8126

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	09/02/2015

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Directions to “CAPSTONE COUNSELING LLC ” Practice Location

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