Provider Demographics
NPI:1932674587
Name:PALACIOS, RAMON JR (CAC LEVEL I)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:PALACIOS
Suffix:JR
Gender:M
Credentials:CAC LEVEL I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2654 IRENE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5416
Mailing Address - Country:US
Mailing Address - Phone:208-946-0344
Mailing Address - Fax:
Practice Address - Street 1:109 ANDERSON ST SE STE 101
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8610
Practice Address - Country:US
Practice Address - Phone:470-377-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3519-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)