| Modern Path. Llc | |
|
3720 Chamblee Dunwoody Rd Ste D2 Atlanta GA 30341-2064 | |
| (678) 802-9355 | |
| Not Available |
| Full Name | Modern Path. Llc |
|---|---|
| Speciality | Counselor |
| Location | 3720 Chamblee Dunwoody Rd Ste D2, Atlanta, Georgia |
| Authorized Official Name and Position | Nicole M Fuentes (OWNER) |
| Authorized Official Contact | 6788029355 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Path. Llc 3720 Chamblee Dunwoody Rd Ste D2 Atlanta GA 30341-2064 Ph: (678) 802-9355 | Modern Path. Llc 3720 Chamblee Dunwoody Rd Ste D2 Atlanta GA 30341-2064 Ph: (678) 802-9355 |
| NPI Number | 1023533106 |
|---|---|
| Provider Enumeration Date | 08/09/2017 |
| Last Update Date | 06/18/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023533106 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | LPC004808 (Georgia) | Primary |
| 101YM0800X | Counselor - Mental Health | MH7359 (Florida) | Secondary |
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