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5604 Wendy Bagwell Parkway Suite 211 Hiram GA 30141-7814 | |
| (770) 485-2202 | |
| (770) 575-0456 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 5604 Wendy Bagwell Parkway, Hiram, Georgia |
| Authorized Official Name and Position | Sonja Yvette Hopkins (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7704852202 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5604 Wendy Bagwell Parkway Hiriam GA 30141-7814 Ph: (770) 485-2202 | 5604 Wendy Bagwell Parkway Suite 211 Hiram GA 30141-7814 Ph: (770) 485-2202 |
| NPI Number | 1043425416 |
|---|---|
| Provider Enumeration Date | 05/11/2007 |
| Last Update Date | 05/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043425416 | NPI | - | NPPES |
| 040676383A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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