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NPI Code Detail

MEDICARE: MARIETTA PASTORAL COUNSELING CENTER, INC.

MEDICARE: MARIETTA PASTORAL COUNSELING CENTER, INC.
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
1101YP2500XProfessional CounselorLPC003627GA

General Provider Information

NPI Number : 1538123104
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARIETTA PASTORAL COUNSELING CENTER, INC.
Provider Business Mailing Address
First Line : 316 ALEXANDER ST SE STE 2
Second Line :
City : MARIETTA
State : GA
Zip : 30060-2001
Country : US
Telephone Number : 678-524-4158
Fax Number :
Provider Business Practice Location Address
First Line : 316 ALEXANDER ST SE STE 2
Second Line :
City : MARIETTA
State : GA
Zip : 30060-2001
Country : US
Telephone Number : 678-524-4158
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DR. ALBERT BENJAMIN MORAVITZ
Credential : TH.D., LPC, NCC
Telephone Number : 678-524-4158
Provider Enumeration Date : 04/12/2006
Last Update Date : 06/21/2010

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Directions to “MARIETTA PASTORAL COUNSELING CENTER, INC. ” Practice Location

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