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General NPI Number Information
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NPI Number | 1205695194
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Entity Type | Organization
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Legal Business Name | JOURNEY TO INNER WELLNESS LLC
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Dates
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Enumeration Date | 03/14/2024
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 2242 TOWNSIDE DR
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City | BISHOP
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State | GA
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Zip | 30621-6400
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Country | US
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Telephone | 706-240-0371
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Fax |
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Provider Business Mailing Address
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Address Line | 2242 TOWNSIDE DR
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City | BISHOP
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State | GA
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Zip | 30621-6400
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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 | CEO
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Name | TYSHAWN KINGSBERRY
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Credential |
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Telephone | 706-240-0371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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