Healthcare Provider Details

I. General information

NPI: 1083884332
Provider Name (Legal Business Name): MATRIX EVALUATION AND COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 RIVER EXCHANGE DR 828
NORCROSS GA
30092-4224
US

IV. Provider business mailing address

3100 RIVER EXCHANGE DR 828
NORCROSS GA
30092-4224
US

V. Phone/Fax

Practice location:
  • Phone: 770-364-1074
  • Fax: 770-209-4188
Mailing address:
  • Phone: 770-364-1074
  • Fax: 770-209-4188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. PATRICIA HARRIS
Title or Position: CEO
Credential: CACII, CAMS, MBA
Phone: 770-364-1074