| Diamond Counseling And Coaching, Llc | |
|
135 Bradford Sq Ste B Fayetteville GA 30215-1902 | |
| (678) 886-9112 | |
| (404) 900-9088 |
| Full Name | Diamond Counseling And Coaching, Llc |
|---|---|
| Speciality | Counselor |
| Location | 135 Bradford Sq Ste B, Fayetteville, Georgia |
| Authorized Official Name and Position | Roselande Domond (LICENSE PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 6788869112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diamond Counseling And Coaching, Llc 11658 Kades Trl Hampton GA 30228-4012 Ph: (678) 886-9112 | Diamond Counseling And Coaching, Llc 135 Bradford Sq Ste B Fayetteville GA 30215-1902 Ph: (678) 886-9112 |
| NPI Number | 1497387963 |
|---|---|
| Provider Enumeration Date | 02/12/2020 |
| Last Update Date | 06/29/2020 |
| Certification Date | 06/29/2020 |
| Medicare PECOS PAC ID | 3274064571 |
|---|---|
| Medicare Enrollment ID | O20240926003432 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497387963 | NPI | - | NPPES |
| 003229763A | Medicaid | GA | |
| 003169295B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Roselande Domond |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366847444 PECOS PAC ID: 4183155476 Enrollment ID: I20240926003372 |
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