Provider Demographics
NPI:1710703178
Name:NEW AVENUES ASSESSMENT COUNSELING CENTER
Entity type:Organization
Organization Name:NEW AVENUES ASSESSMENT COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LA TROLL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, RPT, MAC
Authorized Official - Phone:678-982-4046
Mailing Address - Street 1:PO BOX 269
Mailing Address - Street 2:
Mailing Address - City:PORTERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30070-0269
Mailing Address - Country:US
Mailing Address - Phone:678-982-4046
Mailing Address - Fax:
Practice Address - Street 1:1805 OVER LAKE DR SE STE D
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1790
Practice Address - Country:US
Practice Address - Phone:678-982-4046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty