Healthcare Provider Details

I. General information

NPI: 1669879888
Provider Name (Legal Business Name): ROMERO HUFFSTEAD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 RIDGEBEND WAY SE
MABLETON GA
30126-3643
US

IV. Provider business mailing address

1420 RIDGEBEND WAY SE
MABLETON GA
30126-3643
US

V. Phone/Fax

Practice location:
  • Phone: 404-905-1344
  • Fax:
Mailing address:
  • Phone: 678-632-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: