MEDICARE: AKOMA COUNSELING & CONSULTING, INC

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	251S00000X	Community/Behavioral Health Agency		GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144642224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AKOMA COUNSELING & CONSULTING, INC

Provider Business Mailing Address
First Line	:	PO BOX 2639
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30031-2639
Country	:	US
Telephone Number	:	404-378-7309
Fax Number	:	404-378-7310

Provider Business Practice Location Address
First Line	:	125 E TRINITY PL
Second Line	:	SUITE 310
City	:	DECATUR
State	:	GA
Zip	:	30030-3360
Country	:	US
Telephone Number	:	404-378-7309
Fax Number	:	404-378-7310

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LEROY E REESE JR.
Credential	:	PHD
Telephone Number	:	404-378-7309

Provider Enumeration Date	:	01/09/2014
Last Update Date	:	01/09/2014

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