MEDICARE: ATLANTA VININGS COUNSELING SERVICE

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	251S00000X	Community/Behavioral Health Agency	LPC007826	GA

General Provider Information

NPI Number	:	1528509874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA VININGS COUNSELING SERVICE

Provider Business Mailing Address
First Line	:	1326 CONCORD RD SE
Second Line	:	SUITE C
City	:	SMYRNA
State	:	GA
Zip	:	30080-5309
Country	:	US
Telephone Number	:	678-644-5619
Fax Number	:

Provider Business Practice Location Address
First Line	:	1326 CONCORD RD SE
Second Line	:	SUITE C
City	:	SMYRNA
State	:	GA
Zip	:	30080-5309
Country	:	US
Telephone Number	:	678-644-5619
Fax Number	:

Authorized Official
Title or Position	:	COUNSELING PSYCHOLOGIST
Name	:	DR. ANDREA ANN MARIE FRANCIS
Credential	:	MA, M.ED., PHD,
Telephone Number	:	678-644-5619

Provider Enumeration Date	:	03/19/2017
Last Update Date	:	04/07/2017

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