Healthcare Provider Details

I. General information

NPI: 1235758822
Provider Name (Legal Business Name): ECCTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 AMAL DR SW APT 2018
ATLANTA GA
30315-4878
US

IV. Provider business mailing address

302 W 5TH ST STE 308
SAN PEDRO CA
90731-2750
US

V. Phone/Fax

Practice location:
  • Phone: 470-232-0404
  • Fax:
Mailing address:
  • Phone: 470-232-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MIYUME MCKINLEY
Title or Position: OWNER
Credential: LCSW
Phone: 424-376-8705