Healthcare Provider Details

I. General information

NPI: 1780505198
Provider Name (Legal Business Name): SEEDS FOR SUCCESS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 JAMES B RIVERS MEMORIAL DR
STONE MOUNTAIN GA
30083-2955
US

IV. Provider business mailing address

PO BOX 602
STONE MOUNTAIN GA
30086-0602
US

V. Phone/Fax

Practice location:
  • Phone: 678-658-0906
  • Fax:
Mailing address:
  • Phone: 678-658-0906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA MICHAEL JACOBSON
Title or Position: OWNER
Credential:
Phone: 678-658-0906