Charles O'Connor | Atlanta, GA • PECOS Search

Charles O'Connor

Counselor

Behavioral Health & Social Service Providers

3091 E Shadowlawn Ave NE, Atlanta, GA 30305-2481

PECOS Enrollment

Based on the most recent information from CMS, provider Charles O'Connor does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:47 AM.

Profile Details

Provider ID
1487923611
Provider Type
Individual
Full Name
O'Connor, Charles
Title
Mr.
Credential
LPC

Gender
Male
Sole Proprietor
Yes
Enumeration Date
12/16/2011
Last Updated
12/16/2011

Contact Information

Practice Location

3091 E Shadowlawn Ave NE, Atlanta, GA 30305-2481

Unlisted Fax

Mailing Location

4012 Union Walk Cir SE, Smyrna, GA 30082-3657

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License LPC006312 Georgia