| Atvl Llc | |
|
2630 Caladium Dr Ne Atlanta GA 30345-1352 | |
| (470) 635-9499 | |
| Not Available |
| Full Name | Atvl Llc |
|---|---|
| Speciality | Counselor |
| Location | 2630 Caladium Dr Ne, Atlanta, Georgia |
| Authorized Official Name and Position | Janice M Barrocas (CEO) |
| Authorized Official Contact | 4048055134 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Atvl Llc 2630 Caladium Dr Ne Atlanta GA 30345-1352 Ph: (470) 635-9499 | Atvl Llc 2630 Caladium Dr Ne Atlanta GA 30345-1352 Ph: (470) 635-9499 |
| NPI Number | 1447941885 |
|---|---|
| Provider Enumeration Date | 05/17/2023 |
| Last Update Date | 05/17/2023 |
| Certification Date | 05/17/2023 |
| Medicare PECOS PAC ID | 7214388362 |
|---|---|
| Medicare Enrollment ID | O20240112002302 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447941885 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Janice Machiz Barrocas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467178384 PECOS PAC ID: 8123479276 Enrollment ID: I20240112002408 |
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