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General NPI Number Information
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NPI Number | 1174069207
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Entity Type | Organization
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Legal Business Name | SURVIVING TRANSITIONS, LLC
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 8307 OFFICE PARK DR SUITE E
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6935
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Country | US
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Telephone | 678-796-6174
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Fax | 678-261-1641
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Provider Business Mailing Address
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Address Line | 8307 OFFICE PARK DR SUITE E
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6935
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Country | US
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Telephone | 678-796-6174
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Fax | 678-261-1641
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. SHEVANDER DYKES
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Credential | LPC
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Telephone | 678-934-2041
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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 | LPC007614
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License Number State | GA
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