MEDICARE: LONDON PARKS LPC

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	101YM0800X	Mental Health Counselor	LPC011550	GA

General Provider Information

NPI Number	:	1518713015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONDON PARKS LPC

Provider Business Mailing Address
First Line	:	3269 CASCADE PARC BLVD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-5204
Country	:	US
Telephone Number	:	404-402-8729
Fax Number	:

Provider Business Practice Location Address
First Line	:	3269 CASCADE PARC BLVD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-5204
Country	:	US
Telephone Number	:	404-402-8729
Fax Number	:

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

Provider Enumeration Date	:	04/25/2024
Last Update Date	:	04/25/2024

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Directions to “ LONDON PARKS LPC” Practice Location

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