Provider Demographics
NPI:1528509874
Name:ATLANTA VININGS COUNSELING SERVICE
Entity type:Organization
Organization Name:ATLANTA VININGS COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELING PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:ANN MARIE
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MED, PHD,
Authorized Official - Phone:678-644-5619
Mailing Address - Street 1:1326 CONCORD RD SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-5309
Mailing Address - Country:US
Mailing Address - Phone:678-644-5619
Mailing Address - Fax:
Practice Address - Street 1:1326 CONCORD RD SE
Practice Address - Street 2:SUITE C
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-5309
Practice Address - Country:US
Practice Address - Phone:678-644-5619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-19
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007826251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health