MEDICARE: NORTH ATLANTA COUNSELING ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	101YP1600X	Pastoral Counselor
4	103TC1900X	Counseling Psychologist
5	106H00000X	Marriage & Family Therapist
6	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1457592628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH ATLANTA COUNSELING ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	2312 PEACHFORD RD
Second Line	:	SUITE C
City	:	ATLANTA
State	:	GA
Zip	:	30338-7143
Country	:	US
Telephone Number	:	770-457-3028
Fax Number	:	770-457-3046

Provider Business Practice Location Address
First Line	:	2312 PEACHFORD RD
Second Line	:	SUITE C
City	:	ATLANTA
State	:	GA
Zip	:	30338-7143
Country	:	US
Telephone Number	:	770-457-3028
Fax Number	:	770-457-3046

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. RICHARD BLANKENSHIP
Credential	:	MED, LPC, NCC, CCSAS
Telephone Number	:	770-457-3028

Provider Enumeration Date	:	03/17/2009
Last Update Date	:	03/24/2009

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