Healthcare Provider Details

I. General information

NPI: 1255594974
Provider Name (Legal Business Name): BUTTON UP AMERICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 OLD PEACHTREE ROAD SUITE 101
SUWANEE GA
30042
US

IV. Provider business mailing address

450 OLD PEACHTREE ROAD SUITE 101
SUWANEE GA
30042
US

V. Phone/Fax

Practice location:
  • Phone: 770-895-6043
  • Fax:
Mailing address:
  • Phone: 770-895-6043
  • 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 Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA KENNEDY PAUL-EDOUARD
Title or Position: CEO
Credential:
Phone: 516-303-2644