MEDICARE: POSITIVE PERSEVERANCE COUNSELING SERVICES

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780312389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE PERSEVERANCE COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	1800 PHOENIX BLVD STE 128
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-5555
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 PHOENIX BLVD STE 128
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-5555
Country	:	US
Telephone Number	:	404-947-8951
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PHAEDRA BROWN
Credential	:	LPC
Telephone Number	:	404-947-8951

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	08/11/2022

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Practice Location Address:

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Directions to “POSITIVE PERSEVERANCE COUNSELING SERVICES ” Practice Location

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