Provider Demographics
NPI:1902369390
Name:BARRANCO, JAVIER DOMINGO (MS, APC, NCC)
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:DOMINGO
Last Name:BARRANCO
Suffix:
Gender:M
Credentials:MS, APC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 NORTHSIDE DR NW APT 345
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2670
Mailing Address - Country:US
Mailing Address - Phone:770-668-3394
Mailing Address - Fax:
Practice Address - Street 1:1200 ASHWOOD PKWY STE 400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-4749
Practice Address - Country:US
Practice Address - Phone:770-336-7444
Practice Address - Fax:770-504-3722
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006138101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional