Healthcare Provider Details

I. General information

NPI: 1821704495
Provider Name (Legal Business Name): BR8K THRU SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 06/13/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 MABLETON PKWY SW STE 201
MABLETON GA
30126-3364
US

IV. Provider business mailing address

5701 MABLETON PKWY SW STE 201
MABLETON GA
30126-3364
US

V. Phone/Fax

Practice location:
  • Phone: 470-869-2175
  • Fax:
Mailing address:
  • Phone: 470-869-2175
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JAMIA MORROW
Title or Position: CEO
Credential: LPC
Phone: 202-292-8491