MEDICARE: SOJOURN THERAPY AND WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1871269530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOJOURN THERAPY AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	302 SATELLITE BLVD NE STE 132
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-7184
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2406 SUWANEE POINTE DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-1329
Country	:	US
Telephone Number	:	917-841-9594
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TANYA NATASHA HUNTER
Credential	:	LCSW
Telephone Number	:	917-841-9594

Provider Enumeration Date	:	08/20/2021
Last Update Date	:	08/20/2021

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