Healthcare Provider Details

I. General information

NPI: 1922501576
Provider Name (Legal Business Name): ACORN CENTER FOR COUNSELING, GROWTH, & HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 NORTH AVE NE
ATLANTA GA
30306-4466
US

IV. Provider business mailing address

942 NORTH AVE NE
ATLANTA GA
30306-4466
US

V. Phone/Fax

Practice location:
  • Phone: 678-632-4554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC008726
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLPC008726
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberLPC008726
License Number StateGA

VIII. Authorized Official

Name: REBECCA AHMADI
Title or Position: DIRECTOR
Credential: LPC, RPT
Phone: 404-819-3850