Healthcare Provider Details

I. General information

NPI: 1144552092
Provider Name (Legal Business Name): DIVERSE COUNSELING & PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2941 PIEDMONT RD NE SUITE F
ATLANTA GA
30305-2784
US

IV. Provider business mailing address

2941 PIEDMONT RD NE SUITE F
ATLANTA GA
30305-2784
US

V. Phone/Fax

Practice location:
  • Phone: 404-869-9474
  • Fax: 404-869-6421
Mailing address:
  • Phone: 404-869-9474
  • Fax: 404-869-6421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number002740
License Number StateGA

VIII. Authorized Official

Name: DR. SIGRD YVETTE ELSTON
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 404-869-9474