| The Aquaria Group | |
|
2001 Shawn Wayne Cir Se Atlanta GA 30316-3789 | |
| (678) 281-1626 | |
| Not Available |
| Full Name | The Aquaria Group |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2001 Shawn Wayne Cir Se, Atlanta, Georgia |
| Authorized Official Name and Position | Tavari T Brown (CEO/EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6782811626 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Aquaria Group 5452 Po Box Atlanta GA 31107 Ph: (678) 281-1626 | The Aquaria Group 2001 Shawn Wayne Cir Se Atlanta GA 30316-3789 Ph: (678) 281-1626 |
| NPI Number | 1033401633 |
|---|---|
| Provider Enumeration Date | 05/14/2011 |
| Last Update Date | 04/06/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033401633 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (Georgia) | Primary |
| 251B00000X | Case Management | (Georgia) | Secondary |
| 251S00000X | Community/behavioral Health | (Georgia) | Secondary |
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