Healthcare Provider Details

I. General information

NPI: 1134769961
Provider Name (Legal Business Name): MAGNIFYING EXPECTATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 HUDSON BRIDGE RD
STOCKBRIDGE GA
30281-6387
US

IV. Provider business mailing address

3840 SHENFIELD DR
UNION CITY GA
30291-7119
US

V. Phone/Fax

Practice location:
  • Phone: 678-642-8509
  • Fax:
Mailing address:
  • Phone: 678-642-8509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERON QUNISE CROUCH
Title or Position: CEO
Credential: LPC
Phone: 678-642-8509