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General NPI Number Information
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NPI Number | 1134769961
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Entity Type | Organization
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Legal Business Name | MAGNIFYING EXPECTATIONS LLC
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Dates
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Enumeration Date | 01/09/2020
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 1702 HUDSON BRIDGE RD
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6387
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Country | US
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Telephone | 678-642-8509
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Fax |
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Provider Business Mailing Address
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Address Line | 3840 SHENFIELD DR
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City | UNION CITY
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State | GA
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Zip | 30291-7119
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Country | US
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Telephone | 678-642-8509
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. CHERON QUNISE CROUCH
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Credential | LPC
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Telephone | 678-642-8509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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