Healthcare Provider Details

I. General information

NPI: 1942474184
Provider Name (Legal Business Name): ATLANTA COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6111-C PEACHTREE DUNWOODY ROAD
ATLANTA GA
30328
US

IV. Provider business mailing address

6111-C PEACHTREE DUNWOODY ROAD
ATLANTA GA
30328
US

V. Phone/Fax

Practice location:
  • Phone: 770-396-0232
  • Fax: 770-399-0007
Mailing address:
  • Phone: 770-396-0232
  • Fax: 770-399-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER LYNN WEBB
Title or Position: OFFICE MANAGER
Credential:
Phone: 770-396-0232