Healthcare Provider Details

I. General information

NPI: 1104548049
Provider Name (Legal Business Name): THE FOCUS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 CREEK BOTTOM RD
LOGANVILLE GA
30052-8674
US

IV. Provider business mailing address

1063 CREEK BOTTOM RD
LOGANVILLE GA
30052-8674
US

V. Phone/Fax

Practice location:
  • Phone: 770-596-8714
  • Fax:
Mailing address:
  • Phone: 770-596-8714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. BARBARA LESLIE
Title or Position: ADMINISTRATOR
Credential:
Phone: 770-314-3377