Healthcare Provider Details

I. General information

NPI: 1154597847
Provider Name (Legal Business Name): CVC ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4617 WATERFORD CT
ATLANTA GA
30338-3137
US

IV. Provider business mailing address

4617 WATERFORD CT
ATLANTA GA
30338-3137
US

V. Phone/Fax

Practice location:
  • Phone: 678-579-0637
  • Fax:
Mailing address:
  • Phone: 678-579-0637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number003067
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHLEEN A. CONNORS
Title or Position: PRESIDENT
Credential: PHD
Phone: 678-579-0637