Healthcare Provider Details

I. General information

NPI: 1992258354
Provider Name (Legal Business Name): TURBER ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4103 ROCKS LN
LOGANVILLE GA
30052-6683
US

IV. Provider business mailing address

4103 ROCKS LN
LOGANVILLE GA
30052-6683
US

V. Phone/Fax

Practice location:
  • Phone: 770-891-2678
  • Fax: 770-466-5955
Mailing address:
  • Phone: 770-891-2678
  • Fax: 770-466-5955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberLPC001394
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC001394
License Number StateGA

VIII. Authorized Official

Name: MRS. JANICE BAKER TURBER
Title or Position: CFO
Credential: LPC
Phone: 770-891-2678