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General NPI Number Information
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NPI Number | 1124637053
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Entity Type | Organization
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Legal Business Name | DISTINCTIVE NATURE, LLC
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 2751 BUFORD HWY NE
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City | ATLANTA
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State | GA
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Zip | 30324-3207
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Country | US
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Telephone | 404-907-1934
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Fax | 404-907-1934
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Provider Business Mailing Address
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Address Line | 931 MONROE DR NE STE A102
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City | ATLANTA
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State | GA
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Zip | 30308-2183
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Country | US
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Telephone | 404-907-1934
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | AARON B EVANS-JACKSON
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Credential | LCSW
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Telephone | 404-907-1934
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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 |
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License Number State |
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