Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003044686 |
---|---|
Provider Name | Daniella Atwell |
First Address | Marietta, GA 30067-8650 |
Second Address | Marietta, GA 30067-8650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2009 |
Last Update Date | 03/02/2020 |