Healthcare Provider Details

I. General information

NPI: 1376299388
Provider Name (Legal Business Name): BOYS2MEN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 GEES MILL RD NE STE 217
CONYERS GA
30013-1361
US

IV. Provider business mailing address

2047 GEES MILL RD NE STE 217
CONYERS GA
30013-1361
US

V. Phone/Fax

Practice location:
  • Phone: 678-614-8118
  • Fax: 678-882-3969
Mailing address:
  • Phone: 678-614-8118
  • Fax: 678-882-3969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENNIS JONES
Title or Position: OWNER
Credential: LPC
Phone: 678-614-8118