Healthcare Provider Details

I. General information

NPI: 1356748636
Provider Name (Legal Business Name): NICOLA PINTO LCSW. PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 IRVIN WAY STE 211
DECATUR GA
30030-1724
US

IV. Provider business mailing address

1201 BAYWOOD CIR
MORROW GA
30260-2194
US

V. Phone/Fax

Practice location:
  • Phone: 404-501-0001
  • Fax: 404-501-0023
Mailing address:
  • Phone: 973-803-3763
  • Fax: 877-804-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05599500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number300926
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: