| A Balanced Place, Llc | |
|
4247 Skyline Vw Oakwood GA 30566-4307 | |
| (678) 387-9076 | |
| (678) 807-2834 |
| Full Name | A Balanced Place, Llc |
|---|---|
| Speciality | Counselor |
| Location | 4247 Skyline Vw, Oakwood, Georgia |
| Authorized Official Name and Position | Charyl Durbin (OWNER) |
| Authorized Official Contact | 6783879076 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Balanced Place, Llc 4247 Skyline Vw Oakwood GA 30566-4307 Ph: (678) 387-9076 | A Balanced Place, Llc 4247 Skyline Vw Oakwood GA 30566-4307 Ph: (678) 387-9076 |
| NPI Number | 1003429663 |
|---|---|
| Provider Enumeration Date | 08/24/2020 |
| Last Update Date | 09/02/2020 |
| Certification Date | 09/01/2020 |
| Medicare PECOS PAC ID | 9436693645 |
|---|---|
| Medicare Enrollment ID | O20240628001918 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003429663 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Charyl Durbin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912313826 PECOS PAC ID: 0345784559 Enrollment ID: I20240628002552 |
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