Healthcare Provider Details

I. General information

NPI: 1003630237
Provider Name (Legal Business Name): SOLID FOUNDATION CHRISTIAN ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 MEMORIAL DR
STONE MOUNTAIN GA
30083-3111
US

IV. Provider business mailing address

4045 FIVE FORKS TRICKUM RD SW # D17-124
LILBURN GA
30047-2538
US

V. Phone/Fax

Practice location:
  • Phone: 404-983-0458
  • Fax:
Mailing address:
  • Phone: 404-983-0458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. LESLIE CHARISSE PLEDGER
Title or Position: DIRECTOR
Credential:
Phone: 470-819-9499