Healthcare Provider Details

I. General information

NPI: 1811851652
Provider Name (Legal Business Name): UNTAPPED POTENTIAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8159 W HIGHWAY 136
CHICKAMAUGA GA
30707-4069
US

IV. Provider business mailing address

8159 W HIGHWAY 136
CHICKAMAUGA GA
30707-4069
US

V. Phone/Fax

Practice location:
  • Phone: 404-781-7536
  • Fax:
Mailing address:
  • Phone: 404-781-7536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. ZEFFON WILLS
Title or Position: CEO
Credential:
Phone: 404-781-7536