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General NPI Number Information
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NPI Number | 1164102232
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Entity Type | Organization
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Legal Business Name | POETIC-PROSE MANAGEMENT LLC
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 08/12/2023
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Provider Practice Location Address
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Address Line | 2195 W HIGHTOWER TRL
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City | CONYERS
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State | GA
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Zip | 30012-1820
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Country | US
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Telephone | 470-368-5033
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Fax | 866-651-0172
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Provider Business Mailing Address
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Address Line | PO BOX 3496
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City | LILBURN
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State | GA
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Zip | 30048-3496
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Country | US
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Telephone | 470-368-5033
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Fax | 866-651-0172
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Authorized Official
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Title or Position | FOUNDER/OWER
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Name | MR. STEPHEN B GRANT
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Credential |
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Telephone | 770-330-6987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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