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NPI Code Detail

MEDICARE: ATLANTA INNOVATIVE COUNSELING CENTER, LLC

MEDICARE: ATLANTA INNOVATIVE COUNSELING CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1023675865
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATLANTA INNOVATIVE COUNSELING CENTER, LLC
Provider Business Mailing Address
First Line : 4045 ORCHARD RD SE STE 110
Second Line :
City : SMYRNA
State : GA
Zip : 30080-4904
Country : US
Telephone Number : 770-293-1950
Fax Number :
Provider Business Practice Location Address
First Line : 4045 ORCHARD RD SE STE 110
Second Line :
City : SMYRNA
State : GA
Zip : 30080-4904
Country : US
Telephone Number : 770-293-1950
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. CHRISTI BARTOLOMUCCI
Credential : PH.D.
Telephone Number : 404-808-3370
Provider Enumeration Date : 05/28/2019
Last Update Date : 05/28/2019

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Directions to “ATLANTA INNOVATIVE COUNSELING CENTER, LLC ” Practice Location

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