Healthcare Provider Details

I. General information

NPI: 1821608555
Provider Name (Legal Business Name): BA GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 CLEVELAND AVE
EAST POINT GA
30344-6965
US

IV. Provider business mailing address

535 EFFINGHAM HWY
SYLVANIA GA
30467-7726
US

V. Phone/Fax

Practice location:
  • Phone: 477-329-0110
  • Fax:
Mailing address:
  • Phone: 404-964-0906
  • Fax: 877-268-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KENYOTTA HANNAH
Title or Position: CEO
Credential: LPC
Phone: 404-964-0906