11D2075397 CLIA NUMBER - PROGRESSIVE CONSUMER COUNSELING SERVICES

Laboratory Demographics

  • CLIA Code: 11D2075397
  • Facility Name: PROGRESSIVE CONSUMER COUNSELING SERVICES
  • Facility Address: 6175 OLD NATIONAL HIGHWAY, SUITE 420
    COLLEGE PARK, GA
    ZIP 30349
  • Facility Phone: 404 209-1209
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: MARIO L. BUTLER
  • NPI Number: 1659524775
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 11D2075397
LAB Type Community Clinic
Facility Name PROGRESSIVE CONSUMER COUNSELING SERVICES
Street 6175 OLD NATIONAL HIGHWAY, SUITE 420
City COLLEGE PARK
State GA
ZIP 30349
Phone 404 209-1209
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/30/2025
Certificate Expiration Date 5/29/2027
Facility Type Community Clinic
Lab Director MARIO L. BUTLER

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This page was last updated on: 9/29/2025