Healthcare Provider Details

I. General information

NPI: 1457581126
Provider Name (Legal Business Name): MCGINNIS HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 CHESS CHASE
FAYETTEVILLE GA
30215-4909
US

IV. Provider business mailing address

145 CHESS CHASE
FAYETTEVILLE GA
30215-4909
US

V. Phone/Fax

Practice location:
  • Phone: 404-219-2523
  • Fax: 404-745-8228
Mailing address:
  • Phone: 404-219-2523
  • Fax: 404-745-8228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: JOANETTE YVONNE MCGINNIS
Title or Position: CHIEF EXECUTIVE DIRECTOR
Credential:
Phone: 404-219-2523