Healthcare Provider Details

I. General information

NPI: 1720622459
Provider Name (Legal Business Name): ALFREDO MORALES CELEDON LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 HILLCREST RD NW STE 400
LILBURN GA
30047-6896
US

IV. Provider business mailing address

4221 GRAVITT PL
DULUTH GA
30096-4385
US

V. Phone/Fax

Practice location:
  • Phone: 404-955-3306
  • Fax:
Mailing address:
  • Phone: 404-955-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC011177
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: