MEDICARE: NATIONAL CENTER FOR COMMUNITY SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	103TA0400X	Addiction (Substance Use Disorder) Psychologist
5	103TB0200X	Cognitive & Behavioral Psychologist
6	103TC0700X	Clinical Psychologist
7	103TC2200X	Clinical Child & Adolescent Psychologist
8	103TP0016X	Prescribing (Medical) Psychologist
9	103TP2701X	Group Psychotherapy Psychologist
10	104100000X	Social Worker
11	1041C0700X	Clinical Social Worker
12	106H00000X	Marriage & Family Therapist
13	2084P0800X	Psychiatry Physician
14	251S00000X	Community/Behavioral Health Agency
15	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1679923122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL CENTER FOR COMMUNITY SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	882 MARTIN LUTHER KING JR DR SW STE A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-3606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	882 MARTIN LUTHER KING JR DR SW STE A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-3606
Country	:	US
Telephone Number	:	678-794-4846
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	IDRIS TALIB
Credential	:
Telephone Number	:	678-794-4846

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	06/15/2016

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