MEDICARE: DYAN AUTERSON

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
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1255837209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYAN AUTERSON

Provider Business Mailing Address
First Line	:	5355 MUNDY CT
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30028-4025
Country	:	US
Telephone Number	:	404-630-7051
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 ATLANTA HWY STE 1503
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-1277
Country	:	US
Telephone Number	:	678-722-1031
Fax Number	:

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

Provider Enumeration Date	:	03/30/2018
Last Update Date	:	03/30/2018

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Directions to “ DYAN AUTERSON ” Practice Location

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