Provider Demographics
NPI:1952797219
Name:PHYLLIS CARRERA
Entity type:Organization
Organization Name:PHYLLIS CARRERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENCED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-360-6018
Mailing Address - Street 1:1101 COLLIER RD NW
Mailing Address - Street 2:L-5
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-8231
Mailing Address - Country:US
Mailing Address - Phone:678-360-6018
Mailing Address - Fax:
Practice Address - Street 1:1788 CENTURY BLVD NE STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3321
Practice Address - Country:US
Practice Address - Phone:678-360-6018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006957101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty