Healthcare Provider Details

I. General information

NPI: 1033401633
Provider Name (Legal Business Name): TTB HEALTH CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2011
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SHAWN WAYNE CIR SE
ATLANTA GA
30316-3789
US

IV. Provider business mailing address

5452 PO BOX
ATLANTA GA
31107
US

V. Phone/Fax

Practice location:
  • Phone: 678-281-1626
  • Fax:
Mailing address:
  • Phone: 678-281-1626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateGA

VIII. Authorized Official

Name: MRS. TAVARI T BROWN
Title or Position: CEO/EXECUTIVE DIRECTOR
Credential: LAPC, MPH, NCC,
Phone: 678-281-1626