Healthcare Provider Details

I. General information

NPI: 1003445826
Provider Name (Legal Business Name): TRANSFIGURATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 RYALS ST
SAVANNAH GA
31405-1538
US

IV. Provider business mailing address

2817 RYALS ST
SAVANNAH GA
31405-1538
US

V. Phone/Fax

Practice location:
  • Phone: 912-208-0049
  • Fax: 912-234-7664
Mailing address:
  • Phone: 912-208-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LAKEYA N MITCHELL
Title or Position: CEO/THERAPIST
Credential: LPC
Phone: 912-208-0049