1487734372 NPI number — ATLANTA FAMILY COUNSELING CENTER, INC

Table of content: (NPI 1487734372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487734372 NPI number — ATLANTA FAMILY COUNSELING CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTA FAMILY COUNSELING CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487734372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 CAMDEN HILL RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30045-2448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-513-8988
Provider Business Mailing Address Fax Number:
770-513-2565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 CAMDEN HILL RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30045-2448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-513-8988
Provider Business Practice Location Address Fax Number:
770-513-2565
Provider Enumeration Date:
10/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOLSTAD
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
770-513-8988

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LPC002598 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YM0800X , with the licence number: LPC002598 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC002598 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)