1760558563 NPI number — MRS. MARIE S DRINKO LIC. PROF. COUNSELOR

Table of content: MRS. MARIE S DRINKO LIC. PROF. COUNSELOR (NPI 1760558563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760558563 NPI number — MRS. MARIE S DRINKO LIC. PROF. COUNSELOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRINKO
Provider First Name:
MARIE
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LIC. PROF. COUNSELOR
Provider Gender Code:
F

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:
1760558563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3910 ROBIN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ACWORTH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30101-7244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-975-3206
Provider Business Mailing Address Fax Number:
770-975-3507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3440 BLUE SPRINGS RD
Provider Second Line Business Practice Location Address:
STE 503
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-513-5053
Provider Business Practice Location Address Fax Number:
770-975-3507
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LPC004497 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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