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255 Corporate Center Dr Ste C Stockbridge GA 30281-7376 | |
| (762) 499-3403 | |
| (888) 406-5175 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 255 Corporate Center Dr Ste C, Stockbridge, Georgia |
| Authorized Official Name and Position | Seanna Toso (OWNER) |
| Authorized Official Contact | 7624993403 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
255 Corporate Center Dr Ste C Stockbridge GA 30281-7376 Ph: (762) 499-3403 | 255 Corporate Center Dr Ste C Stockbridge GA 30281-7376 Ph: (762) 499-3403 |
| NPI Number | 1336612076 |
|---|---|
| Provider Enumeration Date | 01/04/2019 |
| Last Update Date | 04/02/2024 |
| Certification Date | 04/02/2024 |
| Medicare PECOS PAC ID | 0749620094 |
|---|---|
| Medicare Enrollment ID | O20240502003737 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336612076 | NPI | - | NPPES |
| 003214786A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Seanna Kathleen Toso |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184165698 PECOS PAC ID: 1658711908 Enrollment ID: I20240502003786 |
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