Provider Demographics
NPI:1851806566
Name:ASPIRATIONAL VISIONS FOR TRAUMATIC EVENTS
Entity Type:Organization
Organization Name:ASPIRATIONAL VISIONS FOR TRAUMATIC EVENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-699-1477
Mailing Address - Street 1:553 TULIP LN
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-1039
Mailing Address - Country:US
Mailing Address - Phone:704-699-1477
Mailing Address - Fax:
Practice Address - Street 1:553 TULIP LN
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-1039
Practice Address - Country:US
Practice Address - Phone:704-699-1477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty