Healthcare Provider Details

I. General information

NPI: 1407224215
Provider Name (Legal Business Name): ONE LOVE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GLENLAKE PKWY STE 130
ATLANTA GA
30328-3495
US

IV. Provider business mailing address

10 GLENLAKE PKWY STE 130
ATLANTA GA
30328-3495
US

V. Phone/Fax

Practice location:
  • Phone: 678-743-1045
  • Fax:
Mailing address:
  • Phone: 678-743-1045
  • Fax: 678-222-3401

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 Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON ADKINS
Title or Position: DIRECTOR
Credential: LCSW
Phone: 678-743-1045