| Success Brand Llc | |
|
11630 Ga-100 Franklin GA 30217 | |
| (404) 466-2050 | |
| Not Available |
| Full Name | Success Brand Llc |
|---|---|
| Speciality | Counselor |
| Location | 11630 Ga-100, Franklin, Georgia |
| Authorized Official Name and Position | John Kennebrew (OWNER) |
| Authorized Official Contact | 4044662050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Success Brand Llc 931 Monroe Dr Ne Ste A Atlanta GA 30308-1793 Ph: (404) 466-2050 | Success Brand Llc 11630 Ga-100 Franklin GA 30217 Ph: (404) 466-2050 |
| NPI Number | 1255077061 |
|---|---|
| Provider Enumeration Date | 05/05/2022 |
| Last Update Date | 05/24/2023 |
| Certification Date | 05/24/2023 |
| Medicare PECOS PAC ID | 9739546722 |
|---|---|
| Medicare Enrollment ID | O20230607000228 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255077061 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| Provider Name | Extriara Charlesh Gates |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033755137 PECOS PAC ID: 1951767797 Enrollment ID: I20230519001983 |
Pathways Center For Behavioral And Developmental Growth Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1206 Franklin Pkwy, Franklin, GA 30217 Phone: 706-675-6399 Fax: 706-675-0254 |