Healthcare Provider Details

I. General information

NPI: 1063060879
Provider Name (Legal Business Name): VIVIANA SILVA-HORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 CHATTAHOOCHEE SUMMIT DR
ATLANTA GA
30339
US

IV. Provider business mailing address

2511 DOUBLE CHURCHES RD # 311
FORTSON GA
31808
US

V. Phone/Fax

Practice location:
  • Phone: 404-790-1610
  • Fax:
Mailing address:
  • Phone: 706-999-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-35925
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number586458
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1723764
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: