Healthcare Provider Details

I. General information

NPI: 1992897573
Provider Name (Legal Business Name): MR. STEVEN LINDENBLATT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 CLAIRMONT RD.
DECATUR GA
30033
US

IV. Provider business mailing address

1324 N HIGHLAND AVE.
ATLANTA GA
30306
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax:
Mailing address:
  • Phone: 404-874-3754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number050376442
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: