MEDICARE: MS. CHANTEL COSTON-LUNDI LLC, NCC

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	LPC014761	GA

General Provider Information

NPI Number	:	1497586689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHANTEL COSTON-LUNDI LLC, NCC

Provider Business Mailing Address
First Line	:	5829 CAMPBELLTON RD SW STE 104 - 1149
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331
Country	:	US
Telephone Number	:	646-450-7355
Fax Number	:

Provider Business Practice Location Address
First Line	:	5829 CAMPBELLTON RD SW STE 104 - 1149
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331
Country	:	US
Telephone Number	:	646-450-7355
Fax Number	:

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

Provider Enumeration Date	:	08/09/2024
Last Update Date	:	08/09/2024

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