Organization
MODERN PATH. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE M FUENTES LPC, LMHC (OWNER)
(678) 802-9355
Entity
Organization
Contact information
Practice address
3720 CHAMBLEE DUNWOODY RD STE D2, ATLANTA, GA 30341-2064
(678) 802-9355
Mailing address
3720 CHAMBLEE DUNWOODY RD STE D2, ATLANTA, GA 30341-2064
(678) 802-9355
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC004808
GA
101YM0800X
Mental Health Counselor
MH7359
FL
Other
Enumeration date
08/09/2017
Last updated
06/18/2019
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