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General NPI Number Information
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NPI Number | 1114269636
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Entity Type | Organization
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Legal Business Name | YOUR JOURNEY, YOUR PATH LLC
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Dates
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Enumeration Date | 03/22/2013
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 3401 NORMAN BERRY DR
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City | EAST POINT
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State | GA
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Zip | 30344-5121
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Country | US
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Telephone | 404-784-6958
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Fax |
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Provider Business Mailing Address
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Address Line | 4125 SUNRISE TRL
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City | COLLEGE PARK
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State | GA
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Zip | 30349-2533
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | VALERIE HUGHLEY
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Credential |
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Telephone | 404-784-6958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004157
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License Number State | GA
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