Provider Demographics
NPI:1578904702
Name:ATLANTIC COUNSELING GROUP
Entity Type:Organization
Organization Name:ATLANTIC COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZZANA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:703-665-0949
Mailing Address - Street 1:20925 PROFESSIONAL PLZ STE 230
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3403
Mailing Address - Country:US
Mailing Address - Phone:703-665-0949
Mailing Address - Fax:
Practice Address - Street 1:20925 PROFESSIONAL PLZ STE 230
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3403
Practice Address - Country:US
Practice Address - Phone:703-665-0949
Practice Address - Fax:703-665-7686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty