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General NPI Number Information
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NPI Number | 1003630237
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Entity Type | Organization
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Legal Business Name | SOLID FOUNDATION CHRISTIAN ACADEMY
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 5140 MEMORIAL DR
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-3111
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Country | US
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Telephone | 404-983-0458
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Fax |
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Provider Business Mailing Address
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Address Line | 4045 FIVE FORKS TRICKUM RD SW # D17-124
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City | LILBURN
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State | GA
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Zip | 30047-2538
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Country | US
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Telephone | 404-983-0458
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. LESLIE CHARISSE PLEDGER
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Credential |
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Telephone | 470-819-9499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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