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General NPI Number Information
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NPI Number | 1417217050
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Entity Type | Organization
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Legal Business Name | AVIONCE HEALTHCARE SOLUTIONS
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 05/16/2012
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Provider Practice Location Address
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Address Line | 2140 MCGEE RD
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City | SNELLVILLE
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State | GA
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Zip | 30078-2980
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Country | US
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Telephone | 678-901-9772
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Fax | 866-864-3408
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Provider Business Mailing Address
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Address Line | 2220 JOHNSON CREEK DR
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City | LITHONIA
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State | GA
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Zip | 30058-5183
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Country | US
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Telephone | 678-901-9772
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Fax | 866-864-3408
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. CAMELIA BEVERLY BALLAH
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Credential |
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Telephone | 770-882-4031
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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 |
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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 |
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License Number State |
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Taxonomy #3
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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 #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 103T00000X
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Taxonomy Name | Psychologist
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003836
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License Number State | GA
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