Healthcare Provider Details

I. General information

NPI: 1699512186
Provider Name (Legal Business Name): COGNITIVE HEALING OF ATLANTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 CORPORATE CENTER DR STE 165
MORROW GA
30260-4130
US

IV. Provider business mailing address

3000 CORPORATE CENTER DR STE 165
MORROW GA
30260-4130
US

V. Phone/Fax

Practice location:
  • Phone: 678-587-8713
  • Fax: 626-227-8314
Mailing address:
  • Phone: 678-587-8713
  • Fax: 626-227-8314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALPHONSO CORNELIUS HEATH JR.
Title or Position: CEO
Credential: LPC
Phone: 585-456-8339