Healthcare Provider Details

I. General information

NPI: 1699614487
Provider Name (Legal Business Name): BECKIE LOVE DE LA MOTHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4393 MINERS CREEK RD
LITHONIA GA
30038-3818
US

IV. Provider business mailing address

4393 MINERS CREEK RD
LITHONIA GA
30038-3818
US

V. Phone/Fax

Practice location:
  • Phone: 404-372-7788
  • Fax:
Mailing address:
  • Phone: 404-372-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number207974
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: