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General NPI Number Information
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NPI Number | 1265825566
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Entity Type | Organization
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Legal Business Name | ATLANTA COUNSELING & DIAGNOTICS CENTER LLC
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Dates
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Enumeration Date | 03/10/2015
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Last Update Date | 12/23/2022
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Provider Practice Location Address
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Address Line | 2090 SUGARLOAF PKWY STE 115
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-9402
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Country | US
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Telephone | 770-658-4833
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Fax |
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Provider Business Mailing Address
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Address Line | 2090 SUGARLOAF PKWY STE 115
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-9402
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Country | US
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Telephone | 770-676-0589
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATER
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Name | MR. JERRELL WALKER
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Credential | LPC
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Telephone | 770-676-0589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 007754
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License Number State | GA
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