MEDICARE: TAJANA TATA PRESIDENT LPC

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
1	101YP2500X	Professional Counselor		GA

General Provider Information

NPI Number	:	1043169691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAJANA TATA PRESIDENT LPC

Provider Business Mailing Address
First Line	:	4304 TRAIPSE PATH
Second Line	:
City	:	ELLENWOOD
State	:	GA
Zip	:	30294-3048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 CLAIREMONT AVE STE 400
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-2546
Country	:	US
Telephone Number	:	404-500-4266
Fax Number	:	404-500-4283

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	02/04/2026

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