Healthcare Provider Details

I. General information

NPI: 1518384106
Provider Name (Legal Business Name): VISIONS OF LIFE BEHAVIORAL HEALTH SERVICES, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 CHAPMAN STREET
JONESBORO GA
30238
US

IV. Provider business mailing address

754 CHAPMAN STREET
JONESBORO GA
30238
US

V. Phone/Fax

Practice location:
  • Phone: 678-389-1337
  • Fax:
Mailing address:
  • Phone: 678-389-1337
  • Fax:

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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DENISE CALDWELL-OBI
Title or Position: CEO/PRESIDENT
Credential:
Phone: 678-389-1337