Provider Demographics
NPI:1710380639
Name:LOTUS COUNSELING CENTER
Entity Type:Organization
Organization Name:LOTUS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CORTINA-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LAMFT
Authorized Official - Phone:770-712-8213
Mailing Address - Street 1:1241 VIRGINIA AVE NE
Mailing Address - Street 2:APT C2
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2872 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8305
Practice Address - Country:US
Practice Address - Phone:770-361-7864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000343251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health