Healthcare Provider Details

I. General information

NPI: 1487734372
Provider Name (Legal Business Name): ATLANTA FAMILY COUNSELING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CAMDEN HILL RD SUITE A
LAWRENCEVILLE GA
30045-2448
US

IV. Provider business mailing address

190 CAMDEN HILL RD SUITE A
LAWRENCEVILLE GA
30045-2448
US

V. Phone/Fax

Practice location:
  • Phone: 770-513-8988
  • Fax: 770-513-2565
Mailing address:
  • Phone: 770-513-8988
  • Fax: 770-513-2565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC002598
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC002598
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC002598
License Number StateGA

VIII. Authorized Official

Name: MS. MICHELE A HOLSTAD
Title or Position: OWNER
Credential: LPC
Phone: 770-513-8988