Healthcare Provider Details

I. General information

NPI: 1437677218
Provider Name (Legal Business Name): LTA COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 05/03/2020
Certification Date: 05/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1774 CENTURY BLVD NE STE B
ATLANTA GA
30345-3312
US

IV. Provider business mailing address

1774 CENTURY BLVD NE STE B
ATLANTA GA
30345-3312
US

V. Phone/Fax

Practice location:
  • Phone: 678-744-3003
  • Fax: 404-420-2104
Mailing address:
  • Phone: 678-744-3003
  • Fax: 404-420-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. LAUREN T ALEXANDER
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LPC, MAC
Phone: 678-744-3003