MEDICARE: EMILY ROSE PRESLEY-PITTS MS IN CMHC

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	101YP2500X	Professional Counselor	LPC011034	GA

General Provider Information

NPI Number	:	1912537218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ROSE PRESLEY-PITTS MS IN CMHC

Provider Business Mailing Address
First Line	:	66 BEAVER CREEK WAY
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528-5693
Country	:	US
Telephone Number	:	678-630-5117
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 NORTH AVE STE 100
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528-1398
Country	:	US
Telephone Number	:	706-348-8674
Fax Number	:	706-348-8676

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

Provider Enumeration Date	:	01/25/2020
Last Update Date	:	05/07/2020

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