Healthcare Provider Details

I. General information

NPI: 1326515636
Provider Name (Legal Business Name): JACQUELINE BECKHOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TRINITY SOCIAL SERVICES, LLC 50 LENOX POINTE, NE SUITE
ATLANTA GA
30324
US

IV. Provider business mailing address

6158 PEMBROKE DR
REX GA
30273-1244
US

V. Phone/Fax

Practice location:
  • Phone: 678-824-6590
  • Fax: 678-228-1258
Mailing address:
  • Phone: 770-875-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: