| Cognitive Healing Of Atlanta Llc | |
|
324 Newburgh Pl Stockbridge GA 30281-2454 | |
| (585) 456-8339 | |
| Not Available |
| Full Name | Cognitive Healing Of Atlanta Llc |
|---|---|
| Speciality | Counselor |
| Location | 324 Newburgh Pl, Stockbridge, Georgia |
| Authorized Official Name and Position | Alphonso Cornelius Heath (CEO) |
| Authorized Official Contact | 5854568339 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cognitive Healing Of Atlanta Llc 1445 Woodmont Ln Nw # 1120 Atlanta GA 30318-2866 Ph: (585) 456-8339 | Cognitive Healing Of Atlanta Llc 324 Newburgh Pl Stockbridge GA 30281-2454 Ph: (585) 456-8339 |
| NPI Number | 1699512186 |
|---|---|
| Provider Enumeration Date | 07/11/2024 |
| Last Update Date | 12/07/2024 |
| Certification Date | 12/07/2024 |
| Medicare PECOS PAC ID | 7618400250 |
|---|---|
| Medicare Enrollment ID | O20241104002700 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699512186 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Alphonso Heath |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1255011821 PECOS PAC ID: 5294270419 Enrollment ID: I20240712000101 |
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