MEDICARE: DR. BERTRINA OLIVIA WEST

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101YM0800X	Mental Health Counselor	GA
2	101YP2500X	Professional Counselor	GA
3	103T00000X	Psychologist

General Provider Information

NPI Number	:	1265993927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERTRINA OLIVIA WEST

Provider Business Mailing Address
First Line	:	3470 MCCLURE BRIDGE RD UNIT 621
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-1105
Country	:	US
Telephone Number	:	404-900-9583
Fax Number	:

Provider Business Practice Location Address
First Line	:	4720 PEACHTREE INDUSTRIAL BLVD STE 4201
Second Line	:
City	:	BERKELEY LAKE
State	:	GA
Zip	:	30071-5738
Country	:	US
Telephone Number	:	404-900-9583
Fax Number	:

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

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	10/21/2025

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