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General NPI Number Information
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NPI Number | 1336670348
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Entity Type | Organization
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Legal Business Name | ATLANTA CENTER FOR SPECIALIZED CARE
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 1 GLENLAKE PKWY 700
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City | ATLANTA
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State | GA
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Zip | 30328-3448
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Country | US
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Telephone | 404-838-8788
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Fax |
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Provider Business Mailing Address
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Address Line | 5095 WINDING BRANCH DR
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City | DUNWOODY
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State | GA
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Zip | 30338-3901
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Country | US
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Telephone | 770-354-1911
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. TATIANA KISIL MATTHEWS
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Credential | LPC
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Telephone | 770-354-1911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3359
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License Number State | GA
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