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General NPI Number Information
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NPI Number | 1881080117
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Entity Type | Organization
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Legal Business Name | ATLANTA BEHAVIORAL & MENTAL HEALTH COUNSELING, LLC
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 59 ANDERSON AVE #308
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City | CANTON
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State | GA
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Zip | 30114-2328
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Country | US
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Telephone | 770-778-6997
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Fax |
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Provider Business Mailing Address
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Address Line | 59 ANDERSON AVENUE # 308
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City | CANTON
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State | GA
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Zip | 30114
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Country | US
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Telephone | 770-778-6997
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MS. ELIZABETH D. GREEN
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Credential | LMSW
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Telephone | 770-778-6997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | MSW006580
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License Number State | GA
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