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General NPI Number Information
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NPI Number | 1225582562
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Entity Type | Organization
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Legal Business Name | DESTINATION GREATNESS-GEORGIA, LLC
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 3343 PEACHTREE RD NE STE 145-1058
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City | ATLANTA
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State | GA
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Zip | 30326-1085
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Country | US
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Telephone | 800-647-3345
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Fax | 866-923-0754
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Provider Business Mailing Address
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Address Line | PO BOX 29144
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City | ATLANTA
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State | GA
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Zip | 30359-0144
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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 | SHANNA AMANDA JEFFERSON
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Credential |
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Telephone | 800-647-3345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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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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