Provider Demographics
NPI:1073127056
Name:BUSTAMANTE COUNSELING
Entity Type:Organization
Organization Name:BUSTAMANTE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTAMANTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:470-991-1619
Mailing Address - Street 1:5235 DEERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3604
Mailing Address - Country:US
Mailing Address - Phone:470-991-1619
Mailing Address - Fax:
Practice Address - Street 1:317 W HILL ST STE 203B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4368
Practice Address - Country:US
Practice Address - Phone:470-991-1619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty