Provider Demographics
NPI:1720622459
Name:MORALES CELEDON, ALFREDO (LPC, NCC)
Entity type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:MORALES CELEDON
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 GRAVITT PL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4385
Mailing Address - Country:US
Mailing Address - Phone:404-955-3306
Mailing Address - Fax:
Practice Address - Street 1:540 POWDER SPRINGS ST STE C17
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3561
Practice Address - Country:US
Practice Address - Phone:404-955-3306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011177101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health