| Ms Christy Elizabeth Black, LPC, ATR-BC | |
|
109 Old Livery Street, Clayton, GA 30525 | |
| (706) 782-0717 | |
| (706) 782-5266 |
| Full Name | Ms Christy Elizabeth Black |
|---|---|
| Gender | Female |
| Speciality | Counselor - Professional |
| Location | 109 Old Livery Street, Clayton, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346380946 | NPI | - | NPPES |
| 10045520 | Other | GA | CMO AMERIGROUP |
| 743718-000 | Other | GA | CMO- MAGELLAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC 003219 (Georgia) | Primary |
| Entity Name | Family Art Therapy Center Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1609916147 PECOS PAC ID: 6406843408 Enrollment ID: O20240304002412 |
| Mailing Address | Practice Location Address |
|---|---|
| Ms Christy Elizabeth Black, LPC, ATR-BC Po Box 1689, Clayton, GA 30525-0043 Ph: (706) 782-0717 | Ms Christy Elizabeth Black, LPC, ATR-BC 109 Old Livery Street, Clayton, GA 30525 Ph: (706) 782-0717 |
Robert Hennen, Counselor Medicare: Not Enrolled in Medicare Practice Location: 236 File St, Clayton, GA 30525 Phone: 888-914-1050 | |
Ms. Barbara H Marshall, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 109 Old Livery Street, Clayton, GA 30525 Phone: 706-782-0717 Fax: 706-782-5266 | |
Mr. Herman Bunn, MA, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 42 Crooked Branch Dr, Clayton, GA 30525 Phone: 706-782-3671 Fax: 706-782-3671 | |
Jeffrey R Scott, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 236 File St, Clayton, GA 30525 Phone: 706-212-2037 Fax: 801-437-2984 | |
Mr. Thomas Gregory Cole, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 44 Cottonwood Street, Clayton, GA 30525 Phone: 706-782-0717 | |
Anne E Wilzbacher, Counselor Medicare: Not Enrolled in Medicare Practice Location: 236 File St, Clayton, GA 30525 Phone: 970-426-9207 |