Healthcare Provider Details

I. General information

NPI: 1508520941
Provider Name (Legal Business Name): CHERISH MOMENTS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 PAVILION CT STE D
MCDONOUGH GA
30253-6666
US

IV. Provider business mailing address

808 PAVILION CT STE D
MCDONOUGH GA
30253-6666
US

V. Phone/Fax

Practice location:
  • Phone: 678-558-2467
  • Fax:
Mailing address:
  • Phone: 678-558-2467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. AQUARIUS S CARD
Title or Position: CEO
Credential: LCSW
Phone: 678-558-2467