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General NPI Number Information
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NPI Number | 1831963016
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Entity Type | Individual
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Provider Name | MS. CARLA NICOLE
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Gender | Female
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 250 GEORGIA AVE SE STE 213
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City | ATLANTA
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State | GA
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Zip | 30312-3000
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Country | US
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Telephone | 404-653-0374
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 DRUID VALLEY DR NE APT E
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City | ATLANTA
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State | GA
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Zip | 30329-2905
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Country | US
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Telephone | 470-494-2461
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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 |
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License Number State |
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