MEDICARE: COUNSELING CAFE LLC

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

General Provider Information

NPI Number	:	1386538122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING CAFE LLC

Provider Business Mailing Address
First Line	:	2193 PALMYRA DR SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-6681
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2470 WINDY HILL RD SE STE 416
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8625
Country	:	US
Telephone Number	:	470-322-9165
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	CAMELLIA AMINZADEH
Credential	:	LPC
Telephone Number	:	404-944-2778

Provider Enumeration Date	:	06/05/2025
Last Update Date	:	06/05/2025

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