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General NPI Number Information
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NPI Number | 1023716206
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Entity Type | Organization
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Legal Business Name | JOURNEY TO RESTORATION, LLC
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 1244 HIGHWAY 138 SW STE 1086
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City | RIVERDALE
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State | GA
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Zip | 30296-1402
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Country | US
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Telephone | 678-750-3854
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Fax |
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Provider Business Mailing Address
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Address Line | 9071 JIMMY LEE CIR
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City | JONESBORO
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State | GA
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Zip | 30238-7009
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Country | US
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Telephone | 856-417-4472
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Fax |
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Authorized Official
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Title or Position | LPC
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Name | TIFFANY SCOTT
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Credential | LPC
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Telephone | 856-417-4472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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