Provider Demographics
NPI:1760539167
Name:ATLANTA COUNSELING & EVALUATION SERVICES, LLC
Entity Type:Organization
Organization Name:ATLANTA COUNSELING & EVALUATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YOUSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS OF SCIENCE
Authorized Official - Phone:678-795-0346
Mailing Address - Street 1:1902 MACY DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-6339
Mailing Address - Country:US
Mailing Address - Phone:678-795-0346
Mailing Address - Fax:678-795-9709
Practice Address - Street 1:1902 MACY DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-6339
Practice Address - Country:US
Practice Address - Phone:678-795-0346
Practice Address - Fax:678-795-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0909261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA513726OtherVALUE OPTION
GA52889675OtherBLUE CROSS BLUEE SHIEL HM
GA102513Medicaid
GA=========OtherMENTAL HEALTH NET
GA102513Medicaid
GA513726OtherVALUE OPTION
GA102513Medicaid
GA=========OtherCORP HEALTH