MEDICARE: DARLENE AMOS CADC-II

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1328	GA

General Provider Information

NPI Number	:	1497526982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLENE AMOS CADC-II

Provider Business Mailing Address
First Line	:	799 TWIN OAKS DR APT 4
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-4036
Country	:	US
Telephone Number	:	917-577-9222
Fax Number	:

Provider Business Practice Location Address
First Line	:	799 TWIN OAKS DR APT 4
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-4036
Country	:	US
Telephone Number	:	917-577-9222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2024
Last Update Date	:	01/12/2024

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Directions to “ DARLENE AMOS CADC-II” Practice Location

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