Provider Demographics
NPI:1497526982
Name:AMOS, DARLENE (CADC-II)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:AMOS
Suffix:
Gender:F
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 TWIN OAKS DR APT 4
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4036
Mailing Address - Country:US
Mailing Address - Phone:917-577-9222
Mailing Address - Fax:
Practice Address - Street 1:799 TWIN OAKS DR APT 4
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4036
Practice Address - Country:US
Practice Address - Phone:917-577-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1328101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)