Healthcare Provider Details

I. General information

NPI: 1235968355
Provider Name (Legal Business Name): TALK THERAPY HOME HEALTH SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S JEFF DAVIS DR
FAYETTEVILLE GA
30215-2416
US

IV. Provider business mailing address

717 S JEFF DAVIS DR
FAYETTEVILLE GA
30215-2416
US

V. Phone/Fax

Practice location:
  • Phone: 678-772-0408
  • Fax: 470-758-8853
Mailing address:
  • Phone: 678-772-0408
  • Fax: 470-758-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RASHEEDA G KIMBRO
Title or Position: CEO
Credential: PMHNP-BC
Phone: 678-772-0408