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General NPI Number Information
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NPI Number | 1336726777
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Entity Type | Individual
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Provider Name | MATTHEW VIERON
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Gender | Male
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 171 VILLAGE PKWY NE BLDG 8A
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City | MARIETTA
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State | GA
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Zip | 30067-4061
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Country | US
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Telephone | 601-668-9312
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Fax |
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Provider Business Mailing Address
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Address Line | 620 PEACHTREE ST NE APT 1206
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City | ATLANTA
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State | GA
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Zip | 30308-2372
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Country | US
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Telephone | 601-668-9312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LPC014255
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License Number State | GA
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