Provider Demographics
NPI:1235546375
Name:NEW AVENUES ASSESSMENT AND COUNSELING CENTER
Entity Type:Organization
Organization Name:NEW AVENUES ASSESSMENT AND COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LA TROLL
Authorized Official - Middle Name:S
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-982-4046
Mailing Address - Street 1:PO BOX 269
Mailing Address - Street 2:
Mailing Address - City:PORTERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30070-0269
Mailing Address - Country:US
Mailing Address - Phone:678-982-4046
Mailing Address - Fax:
Practice Address - Street 1:3192 SPRING ST NW
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2269
Practice Address - Country:US
Practice Address - Phone:678-982-4046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC0003912251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health