Healthcare Provider Details

I. General information

NPI: 1902640055
Provider Name (Legal Business Name): SOCIAL EDVENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46031 GARDNER DR
ALPHARETTA GA
30009-8618
US

IV. Provider business mailing address

5174 MCGINNIS FERRY RD STE 169
ALPHARETTA GA
30005-1792
US

V. Phone/Fax

Practice location:
  • Phone: 404-702-1952
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: BARBARA EARLEY
Title or Position: OWNER/SLP
Credential: M.ED. CCC
Phone: 404-702-1952