Individual
MR. MIKE LATELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC-II
Contact information
Practice address
111 PETROL PT STE A-3, PEACHTREE CITY, GA 30269-1550
(678) 568-9049
Mailing address
111 PETROL PT STE A-3, PEACHTREE CITY, GA 30269-1550
(678) 568-9049
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1241
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1241
GA CERTIFIED ALCOHOL AND DRUG COUNSELOR LEVEL II NUMBER
GA
01
—
3918
GA CERTIFIED DRUG AND ALCOHOL EVALUATOR NUMBER
GA
01
—
809429
INTERNATIONALLY CERTIFIED ALCOHOL AND DRUG COUNSELOR
GA
01
—
EO56
CERTIFIED TELE-MEDICAL ELECTRONIC DRUG AND ALCOHOL COUNSELOR
GA
Enumeration date
08/16/2019
Last updated
08/16/2019
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