MEDICARE: ANGELS RECOVERY

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	101YM0800X	Mental Health Counselor	CSW004248	GA

General Provider Information

NPI Number	:	1255743837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS RECOVERY

Provider Business Mailing Address
First Line	:	1200 INDEPENDENCE WAY
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30093-6810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6755 PEACHTREE INDUSTRIAL BLVD
Second Line	:	110
City	:	ATLANTA
State	:	GA
Zip	:	30360-2223
Country	:	US
Telephone Number	:	404-312-6531
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ELIZABETH TOLEDO
Credential	:
Telephone Number	:	404-312-6531

Provider Enumeration Date	:	05/29/2014
Last Update Date	:	05/29/2014

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Directions to “ANGELS RECOVERY ” Practice Location

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