Healthcare Provider Details

I. General information

NPI: 1700223328
Provider Name (Legal Business Name): THE JOSHUA GENERATION CARE AND CONSULTANT SERVICES. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3781 PRESIDENTIAL PKWY SUITE 140
ATLANTA GA
30340-3702
US

IV. Provider business mailing address

4000 BRANTLEY DR
AUSTELL GA
30106-1559
US

V. Phone/Fax

Practice location:
  • Phone: 404-838-0788
  • Fax: 404-973-0790
Mailing address:
  • Phone: 404-838-0788
  • Fax: 404-973-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC007307
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number08020963
License Number StateGA

VIII. Authorized Official

Name: BRYAN JONES
Title or Position: DIRECTOR
Credential: LPC
Phone: 404-246-2815