Healthcare Provider Details
I. General information
NPI: 1578172987
Provider Name (Legal Business Name): MRD&CA SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/31/2020
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
320 LANIER AVE W STE 200
FAYETTEVILLE GA
30214-7443
US
IV. Provider business mailing address
320 LANIER AVE W STE 200
FAYETTEVILLE GA
30214-7443
US
V. Phone/Fax
- Phone: 404-919-8222
- Fax:
- Phone: 404-919-8222
- Fax: 770-995-1959
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MONIQUE
DARNELL
Title or Position: OWNER
Credential: LPC
Phone: 404-919-8222