Atlanta Christian Counseling LLC
Organization Active NPI Clinical Social Worker · Lagrange, GA
NPI 1619689742 · NPPES record last updated May 8, 2023
Key facts
- NPI
- 1619689742
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- ATLANTA CHRISTIAN COUNSELING LLC
- Practice address
- 15 Fish Camp Road
Lagrange, GA 30240 - Phone
- (681) 242-7651
- NPI assigned
- Dec 20, 2022
- Organization subpart
- No
Authorized official
- Name
- Marlena Janette Pique, LCSW
- Title
- Owner/Therapist
- Phone
- (681) 242-7651
Practitioners 2
-
Marlena Pique, LCSWC
-
Keith Anthony D'Angelo, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230714001080 | GA | Part B Supplier - Clinic/Group Practice | 8426418054 |
Receives reassigned benefits from 1 practitioner Practice locations: Newnan, GA |
National Provider Directory
Locations
4011 Beatline Rd
Ste 12
Long Beach, MS 39560
Phone (228) 800-1445
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | Yes |
Addresses
Primary practice location
15 Fish Camp Road
Lagrange, GA 30240
Mailing address
112 Buena Vista Dr
Long Beach, MS 39560-5703
Phone (681) 242-7651
Other practice location 1
4011 Beatline Rd Ste 12
Long Beach, MS 39560-4138
Phone (681) 242-7651
Other providers in Lagrange, GA
- Sabrina Ann Askew-Hayes
- Brett Askins
- Aspinwall Chiropractic Clinic, L.L.C.
- James R Aspinwall
- At Home Medical, Inc.
- Atlas Neck & Back Center
- Krystal Avula
- William T Ayers Jr.
- Back to Life Chiropractic Center Inc
- Coney Bae
All providers in Lagrange, GA · Clinical Social Worker in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2023. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.