Veronica Blakely
Individual provider Active NPI Mental Health Counselor · Atlanta, GA
NPI 1578889754 · NPPES record last updated Apr 14, 2010
Key facts
- NPI
- 1578889754
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 005630 (GA)
- Practice address
- 3855 Presidential Pkwy
Atlanta, GA 30340-3705 - Phone
- (770) 451-6838
- Fax
- (770) 451-7804
- NPI assigned
- Apr 14, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240102003388 | GA | Practitioner - Mental Health Counselor | 9436509528 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sondermind Provider Network LLC | Current |
Accepting new patients |
Locations
3348 Peachtree Rd NE
Ste 700
Atlanta, GA 30326
Phone (720) 712-7900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 005630 | GA | Yes |
Addresses
Primary practice location
3855 Presidential Pkwy
Atlanta, GA 30340-3705
Mailing address
3855 Presidential Pkwy
Atlanta, GA 30340-3705
Phone (770) 451-6838
Other providers in Atlanta, GA
- Victor Blake
- William T Blake
- Rayne Jahliah Blakely-Lopez
- Chandra Blakely
- Lisa Dove Blakely
- Nakayla Blakemore
- Gerald Blakey
- Lydia Blakey
- Kayla Blalock-Brazile
- Andrew Clark Blalock
All providers in Atlanta, GA · Mental Health Counselor in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.