| Envisioned Purpose Llc | |
|
1477 S Bethany Rd Locust Grove GA 30248 | |
| (470) 765-8770 | |
| Not Available |
| Full Name | Envisioned Purpose Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1477 S Bethany Rd, Locust Grove, Georgia |
| Authorized Official Name and Position | Kristina Nemard (PSYCHOTHERAPIST) |
| Authorized Official Contact | 4047595402 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Envisioned Purpose Llc 2045 Mount Zion Rd # 126 Morrow GA 30260-3313 Ph: () - | Envisioned Purpose Llc 1477 S Bethany Rd Locust Grove GA 30248 Ph: (470) 765-8770 |
| NPI Number | 1366018541 |
|---|---|
| Provider Enumeration Date | 05/28/2021 |
| Last Update Date | 05/28/2021 |
| Certification Date | 05/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366018541 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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