Healthcare Provider Details

I. General information

NPI: 1073752341
Provider Name (Legal Business Name): YIELDED HOPE COUNSELING COACHING & CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 ROCKBRIDGE RD SUITE 200
STONE MOUNTAIN GA
30087-3551
US

IV. Provider business mailing address

2045 ROCKBRIDGE RD SUITE 200
STONE MOUNTAIN GA
30087-3551
US

V. Phone/Fax

Practice location:
  • Phone: 404-445-1436
  • Fax:
Mailing address:
  • Phone: 404-445-1436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC005432
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLPC005432
License Number StateGA

VIII. Authorized Official

Name: MS. TAMMY T YOUNG
Title or Position: PROFESSIONAL COUNSELOR
Credential: MA, LPC
Phone: 404-916-4645