Provider Demographics
NPI:1992414395
Name:STRICKLAND, TREVOR GRANT (APC)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:GRANT
Last Name:STRICKLAND
Suffix:
Gender:M
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4448 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7033
Mailing Address - Country:US
Mailing Address - Phone:706-528-7213
Mailing Address - Fax:
Practice Address - Street 1:550 PHARR RD NE STE 605
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3469
Practice Address - Country:US
Practice Address - Phone:404-235-5982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008794101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor