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General NPI Number Information
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NPI Number | 1104798438
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Entity Type | Organization
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Legal Business Name | AMBITIOUS COMPASSION WELLNESS COUNSELING
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 2001 MARTIN LUTHER KING JR DR SW STE 210
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City | ATLANTA
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State | GA
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Zip | 30310-5800
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Country | US
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Telephone | 404-839-0218
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Fax | 470-878-3156
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Provider Business Mailing Address
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Address Line | 2290 LAKE ROYALE DR
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City | RIVERDALE
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State | GA
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Zip | 30296-1896
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Country | US
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Telephone | 404-839-0218
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Fax | 470-878-3156
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Authorized Official
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Title or Position | CEO
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Name | DESIREA R RUSSELL
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Credential | MS, CRC, LPC
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Telephone | 678-709-8002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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