Port of Peace Counseling LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

CSW004124 Issued in GA

Legal business name

PORT OF PEACE COUNSELING LLC

Practice address

8305 Office Park Dr
B
Douglasville, GA 30134-6935

Phone

(404) 291-8931

NPI assigned

Jan 12, 2011

Last updated

Jan 12, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marie-Violene Mertilus, LCSWNPI 1578867073

Title

Therapist

Phone

(404) 291-8931

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marie-Violene Mertilus, LCSW

  • Clinical Social Worker
  • Douglasville, GA
  • NPI 1578867073
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294790400000",
    "number": "1811292477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1262",
            "city": "LITHIA SPRINGS",
            "state": "GA",
            "postal_code": "301221165",
            "telephone_number": "404-291-8931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8305 OFFICE PARK DR",
            "address_2": "B",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301346935",
            "telephone_number": "404-291-8931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT OF PEACE COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-12",
        "last_updated": "2011-01-12",
        "status": "A",
        "authorized_official_last_name": "MERTILUS",
        "authorized_official_first_name": "MARIE-VIOLENE",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "404-291-8931",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "CSW004124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Populations and Interventions Team Company (Pitc)
• Populations and Interventions Team Company (Pitc)
• Populations and Interventions Team Company (Pitc)
• Populations and Interventions Team Company (Pitc)
• Populations and Interventions Team Company (Pitc)
• Brandy K Porter, LCSW, CAADC
• Joya E Porties
• April Annette Potter, REGISTERED NURSE
• De'Shalah Potter, RN
• Beverly Pottinger Pickens, D.O.

• Community/Behavioral Health Agency in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.