Provider Demographics
NPI:1023675865
Name:ATLANTA INNOVATIVE COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:ATLANTA INNOVATIVE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTOLOMUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-808-3370
Mailing Address - Street 1:4045 ORCHARD RD SE STE 110
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4904
Mailing Address - Country:US
Mailing Address - Phone:770-293-1950
Mailing Address - Fax:
Practice Address - Street 1:4045 ORCHARD RD SE STE 110
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4904
Practice Address - Country:US
Practice Address - Phone:770-293-1950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty