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General NPI Number Information
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NPI Number | 1073968921
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Entity Type | Organization
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Legal Business Name | EXPECT GREAT THINGS LLC
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 3350 RIVERWOOD PKWY SE STE 1900
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City | ATLANTA
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State | GA
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Zip | 30339-3372
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Country | US
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Telephone | 770-789-6403
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Fax | 770-628-0106
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Provider Business Mailing Address
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Address Line | 3350 RIVERWOOD PKWY SE STE 1900
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City | ATLANTA
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State | GA
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Zip | 30339-3372
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Country | US
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Telephone | 770-789-6403
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Fax | 770-628-0106
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | JIVANDA VERMELL GREGG MARTIN
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Credential | LPC,CPSC,CAMS II
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Telephone | 770-789-6403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 005239
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License Number State | GA
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