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General NPI Number Information
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NPI Number | 1699512186
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Entity Type | Organization
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Legal Business Name | COGNITIVE HEALING OF ATLANTA LLC
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Dates
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Enumeration Date | 07/11/2024
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Last Update Date | 12/07/2024
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Provider Practice Location Address
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Address Line | 324 NEWBURGH PL
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-2454
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Country | US
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Telephone | 585-456-8339
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Fax |
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Provider Business Mailing Address
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Address Line | 1445 WOODMONT LN NW # 1120
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City | ATLANTA
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State | GA
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Zip | 30318-2866
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Country | US
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Telephone | 585-456-8339
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALPHONSO CORNELIUS HEATH JR.
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Credential | LPC
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Telephone | 585-456-8339
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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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