MEDICARE: ICAN THINK POSITIVE COUNSELING AND COACHING 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1962824466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICAN THINK POSITIVE COUNSELING AND COACHING SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 165
Second Line	:
City	:	REDAN
State	:	GA
Zip	:	30074-0165
Country	:	US
Telephone Number	:	678-999-2611
Fax Number	:

Provider Business Practice Location Address
First Line	:	5405 MEMORIAL DR BLDG C
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-3234
Country	:	US
Telephone Number	:	678-999-2611
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	TINITA SIMMONDS
Credential	:	LPC
Telephone Number	:	770-256-0099

Provider Enumeration Date	:	01/17/2014
Last Update Date	:	07/21/2022

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