MEDICARE: AISHA CLAIRE CALHOUN

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	101YP2500X	Professional Counselor	LPC005685	GA

General Provider Information

NPI Number	:	1487011342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AISHA CLAIRE CALHOUN

Provider Business Mailing Address
First Line	:	1510 BOULEVARD LORRAINE SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-3917
Country	:	US
Telephone Number	:	404-316-8708
Fax Number	:	404-616-1743

Provider Business Practice Location Address
First Line	:	1510 BOULEVARD LORRAINE SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-3917
Country	:	US
Telephone Number	:	404-316-8708
Fax Number	:	404-616-1743

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

Provider Enumeration Date	:	01/24/2016
Last Update Date	:	01/24/2016

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