=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750970117
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ON THE LEVEL COUNSELING THERAPY & TRAINING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2021
-----------------------------------------------------
Last Update Date | 01/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 366 WELLINGTON ST SW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30310-1239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-329-0864
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 366 WELLINGTON ST SW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30310-1239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-329-0864
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LCSW
-----------------------------------------------------
Name | MORRONDO EDWARDS-ROBERTS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-329-0864
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------