Healthcare Provider Details

I. General information

NPI: 1982058285
Provider Name (Legal Business Name): WILLINTON COOLEY MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 LINCOLN PKWY E STE 120
ATLANTA GA
30346-2227
US

IV. Provider business mailing address

1455 LINCOLN PKWY E STE 120
ATLANTA GA
30346-2227
US

V. Phone/Fax

Practice location:
  • Phone: 678-824-6590
  • Fax: 678-824-6597
Mailing address:
  • Phone: 678-824-6590
  • Fax: 678-824-6597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: