Healthcare Provider Details

I. General information

NPI: 1073150934
Provider Name (Legal Business Name): ONESOURCE LEARNING & DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W PARK PLACE BLVD STE 100
STONE MOUNTAIN GA
30087-3561
US

IV. Provider business mailing address

4002 HIGHWAY 78 W STE 530-347
SNELLVILLE GA
30039-7915
US

V. Phone/Fax

Practice location:
  • Phone: 404-965-1499
  • Fax:
Mailing address:
  • Phone: 404-965-1499
  • 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 Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY DAVIS
Title or Position: CREDENTIALING SPECIALISTS
Credential:
Phone: 912-373-4385