| 2thedegree | |
|
159 Burke St Ste 250 Stockbridge GA 30281-3430 | |
| (470) 206-1260 | |
| (678) 550-4207 |
| Full Name | 2thedegree |
|---|---|
| Speciality | Counselor - Professional |
| Location | 159 Burke St Ste 250, Stockbridge, Georgia |
| Authorized Official Name and Position | Naomi Black (CEO/MANAGING DIRECTOR) |
| Authorized Official Contact | 4702061260 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 2thedegree 159 Burke St Ste 205 Stockbridge GA 30281-3428 Ph: (470) 206-1262 | 2thedegree 159 Burke St Ste 250 Stockbridge GA 30281-3430 Ph: (470) 206-1260 |
| NPI Number | 1760004758 |
|---|---|
| Provider Enumeration Date | 05/12/2020 |
| Last Update Date | 06/09/2021 |
| Certification Date | 06/09/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760004758 | NPI | - | NPPES |
| 003234513A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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