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General NPI Number Information
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NPI Number | 1144588682
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Entity Type | Organization
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Legal Business Name | I CARE MENTAL HEALTH INC.
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 2591 MACON DR SW
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City | ATLANTA
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State | GA
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Zip | 30315-8305
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Country | US
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Telephone | 404-762-7904
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Fax | 404-768-4205
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Provider Business Mailing Address
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Address Line | 2591 MACON DR SW
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City | ATLANTA
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State | GA
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Zip | 30315-8305
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Country | US
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Telephone | 404-762-7904
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Fax | 404-768-4205
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Authorized Official
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Title or Position | CEO
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Name | MR. JAMES AGBOOLA ABOLARIN
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Credential | THERAPIST
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Telephone | 404-429-7173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | APC003377
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License Number State | GA
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