| Black Gem Solutions | |
|
1 W Court Sq Ste 750 Decatur GA 30030-2545 | |
| (404) 494-7700 | |
| Not Available |
| Full Name | Black Gem Solutions |
|---|---|
| Speciality | Counselor |
| Location | 1 W Court Sq Ste 750, Decatur, Georgia |
| Authorized Official Name and Position | Kendall Kip Sentimore (LCSW/THERAPIST) |
| Authorized Official Contact | 4044947700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Gem Solutions 1 W Court Sq Ste 750 Decatur GA 30030-2545 Ph: (404) 494-7700 | Black Gem Solutions 1 W Court Sq Ste 750 Decatur GA 30030-2545 Ph: (404) 494-7700 |
| NPI Number | 1568055473 |
|---|---|
| Provider Enumeration Date | 02/11/2021 |
| Last Update Date | 02/11/2021 |
| Certification Date | 02/11/2021 |
| Medicare PECOS PAC ID | 1759790314 |
|---|---|
| Medicare Enrollment ID | O20210614002374 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568055473 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Kendall Sentimore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538464631 PECOS PAC ID: 0345640280 Enrollment ID: I20210615000668 |
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