Healthcare Provider Details

I. General information

NPI: 1851082200
Provider Name (Legal Business Name): CDG ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S WATER ST STE 208
HENDERSON NV
89015-7226
US

IV. Provider business mailing address

532 HOLICK AVE
HENDERSON NV
89011-4339
US

V. Phone/Fax

Practice location:
  • Phone: 770-231-4792
  • Fax: 404-891-4140
Mailing address:
  • Phone: 770-880-9470
  • Fax: 404-891-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CAMILLE DIONE GRIER
Title or Position: OWNER
Credential: LPC
Phone: 770-880-9470