Healthcare Provider Details

I. General information

NPI: 1043835747
Provider Name (Legal Business Name): REBUILDING HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2392 HARPERS WAY
DULUTH GA
30097-5176
US

IV. Provider business mailing address

2392 HARPERS WAY
DULUTH GA
30097-5176
US

V. Phone/Fax

Practice location:
  • Phone: 601-527-3533
  • Fax: 678-903-4190
Mailing address:
  • Phone: 601-527-3533
  • Fax: 678-903-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THERESA MOSLEY
Title or Position: OWNER
Credential: EDD, LMFT
Phone: 601-527-3533