Healthcare Provider Details

I. General information

NPI: 1487233433
Provider Name (Legal Business Name): C.E.O. PROFESSIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 HOLCOMB BRIDGE RD STE 400
PEACHTREE CORNERS GA
30092-2205
US

IV. Provider business mailing address

PO BOX 3037
DULUTH GA
30096-0052
US

V. Phone/Fax

Practice location:
  • Phone: 404-994-6304
  • Fax: 912-539-6565
Mailing address:
  • Phone: 678-383-7093
  • Fax: 912-539-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MAGAEN HARRIS
Title or Position: THERAPIST/ OWNER/ CEO
Credential: LPC
Phone: 404-994-6304