MEDICARE: IRVING COUNSELING & WELLNESS 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1942075072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRVING COUNSELING & WELLNESS LLC

Provider Business Mailing Address
First Line	:	2110 GARDEN PL
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-2948
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 GARDEN PL
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-2948
Country	:	US
Telephone Number	:	404-545-7202
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY IRVING
Credential	:
Telephone Number	:	404-545-7202

Provider Enumeration Date	:	11/20/2023
Last Update Date	:	11/20/2023

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