Healthcare Provider Details

I. General information

NPI: 1023431210
Provider Name (Legal Business Name): ACCESS MENTAL HEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 LAKEWOOD WAY SW 205
ATLANTA GA
30315-6022
US

IV. Provider business mailing address

215 LAKEWOOD WAY SW 205
ATLANTA GA
30315-6022
US

V. Phone/Fax

Practice location:
  • Phone: 678-335-9010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number005397
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number006044
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number006188
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number006400
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number006760
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number006205
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number046882
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number10576464
License Number StateGA
# 9
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number005536
License Number StateGA

VIII. Authorized Official

Name: RODERICK BROWN
Title or Position: OWNER
Credential:
Phone: 678-335-9010