Healthcare Provider Details

I. General information

NPI: 1881586220
Provider Name (Legal Business Name): JOSHUA FERNANDES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 ARCHMONT CIR
DACULA GA
30019-4554
US

IV. Provider business mailing address

1715 ARCHMONT CIR
DACULA GA
30019-4554
US

V. Phone/Fax

Practice location:
  • Phone: 678-800-5851
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC011018
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: