Healthcare Provider Details

I. General information

NPI: 1831004399
Provider Name (Legal Business Name): AGNUS DEI MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1296 LONGREEN TERRACE NW UNIT 6
ATLANTA GA
30318
US

IV. Provider business mailing address

4355 COBB PKWY SE # J-215
ATLANTA GA
30339-4657
US

V. Phone/Fax

Practice location:
  • Phone: 404-859-2595
  • Fax: 404-859-2595
Mailing address:
  • Phone: 404-859-2595
  • Fax: 404-859-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BELINDA J GOSS
Title or Position: CEO/FOUNDER
Credential:
Phone: 404-859-2595