Healthcare Provider Details

I. General information

NPI: 1811607336
Provider Name (Legal Business Name): NIDESH CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S PARKWOOD DR
SAVANNAH GA
31404-5213
US

IV. Provider business mailing address

50 S PARKWOOD DR
SAVANNAH GA
31404-5213
US

V. Phone/Fax

Practice location:
  • Phone: 912-507-0326
  • Fax:
Mailing address:
  • Phone: 912-507-0326
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHATARA JACKSON
Title or Position: CEO/OWNER
Credential: LCSW
Phone: 912-507-0326