MEDICARE: ATK MARRIAGE AND FAMILY COACHING, LLC

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1770105587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATK MARRIAGE AND FAMILY COACHING, LLC

Provider Business Mailing Address
First Line	:	863 DUNCAN RD
Second Line	:
City	:	OXFORD
State	:	GA
Zip	:	30054-3679
Country	:	US
Telephone Number	:	678-609-8203
Fax Number	:

Provider Business Practice Location Address
First Line	:	8218 HAZELBRAND RD NE STE A
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-1516
Country	:	US
Telephone Number	:	678-609-8203
Fax Number	:

Authorized Official
Title or Position	:	LICENSED MARRIAGE & FAMILY THERAPIS
Name	:	KEYNIA DIONNE HARDLEY
Credential	:	LMFT
Telephone Number	:	678-609-8203

Provider Enumeration Date	:	05/14/2020
Last Update Date	:	05/14/2020

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