Healthcare Provider Details

I. General information

NPI: 1316694318
Provider Name (Legal Business Name): TAKES A VILLAGE II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13010 MORRIS RD STE 650
ALPHARETTA GA
30004-5197
US

IV. Provider business mailing address

PO BOX 1442
HOPEWELL VA
23860-1442
US

V. Phone/Fax

Practice location:
  • Phone: 507-400-8839
  • Fax: 804-800-4483
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LA-TOYA JENKINS
Title or Position: DIRECTOR/ CLINICIAN
Credential:
Phone: 804-404-8241