| Empowering Youth For Positive Change | |
|
11555 Medlock Bridge Rd Ste 100 Duluth GA 30097-3200 | |
| (404) 341-6008 | |
| Not Available |
| Full Name | Empowering Youth For Positive Change |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 11555 Medlock Bridge Rd Ste 100, Duluth, Georgia |
| Authorized Official Name and Position | Towanda Denise Hickman (CEO/ OWNER) |
| Authorized Official Contact | 8049086088 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Empowering Youth For Positive Change Po Box 1201 Tappahannock VA 22560-1201 Ph: (804) 443-4428 | Empowering Youth For Positive Change 11555 Medlock Bridge Rd Ste 100 Duluth GA 30097-3200 Ph: (404) 341-6008 |
| NPI Number | 1538446679 |
|---|---|
| Provider Enumeration Date | 11/03/2011 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538446679 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1504 (Virginia) | Primary |
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