Mary Agnes Dallas
Counselor, Mental Health in Atlanta, GA. Individual provider (NPI-1).
NPI number1043674443
StatusActive
Last updated in NPPESApr 12, 2016
Details
- NPI
- 1043674443
- Entity type
- Individual (NPI-1)
- Name
- Mary Agnes Dallas
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 12, 2016
- Last updated
- Apr 12, 2016
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | – | – | Yes |
Practice location
2302 Parklake Dr NeSuite 350
Atlanta, GA 30345-2896
Phone 770-621-0469 · Fax 770-621-0466
Mailing address
2302 Parklake Dr NeSuite 350
Atlanta, GA 30345-2896
Phone 770-621-0469 · Fax 770-621-0466
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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