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1885 Weston Ln Tucker GA 30084-5503 | |
| (678) 431-0064 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1885 Weston Ln, Tucker, Georgia |
| Authorized Official Name and Position | Chassity Todd (CEO) |
| Authorized Official Contact | 6784310064 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1885 Weston Ln Tucker GA 30084-5503 Ph: (678) 431-0064 | 1885 Weston Ln Tucker GA 30084-5503 Ph: (678) 431-0064 |
| NPI Number | 1235973488 |
|---|---|
| Provider Enumeration Date | 06/22/2024 |
| Last Update Date | 12/10/2024 |
| Certification Date | 12/06/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235973488 | NPI | - | NPPES |
| 1275286544 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 171400000X | Health & Wellness Coach | (* (Not Available)) | Secondary |
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