MEDICARE: DIVERSE COUNSELING & PSYCHOLOGICAL ASSOCIATES, 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	251S00000X	Community/Behavioral Health Agency	002740	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	:	1144552092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSE COUNSELING & PSYCHOLOGICAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	2941 PIEDMONT RD NE
Second Line	:	SUITE F
City	:	ATLANTA
State	:	GA
Zip	:	30305-2784
Country	:	US
Telephone Number	:	404-869-9474
Fax Number	:	404-869-6421

Provider Business Practice Location Address
First Line	:	2941 PIEDMONT RD NE
Second Line	:	SUITE F
City	:	ATLANTA
State	:	GA
Zip	:	30305-2784
Country	:	US
Telephone Number	:	404-869-9474
Fax Number	:	404-869-6421

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. SIGRD YVETTE ELSTON
Credential	:	PH.D.
Telephone Number	:	404-869-9474

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	02/03/2010

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