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General NPI Number Information
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NPI Number | 1659524775
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE CONSUMER COUNSELING
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Dates
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Enumeration Date | 11/03/2008
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 6175 OLD NATIONAL HWY STE 420
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City | COLLEGE PARK
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State | GA
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Zip | 30349-4470
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Country | US
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Telephone | 404-209-1209
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Fax |
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Provider Business Mailing Address
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Address Line | 6175 OLD NATIONAL HWY STE 420
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City | COLLEGE PARK
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State | GA
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Zip | 30349-4470
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Country | US
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Telephone | 404-209-1209
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. MARIO BUTLER
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Credential |
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Telephone | 404-209-1209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 1501037234
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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