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General NPI Number Information
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NPI Number | 1245380435
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Entity Type | Organization
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Legal Business Name | PERSONAL ENRICHMENT SERVICES, INC.
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2801 BUFORD HWY NE SUITE 503
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City | ATLANTA
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State | GA
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Zip | 30329-2149
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Country | US
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Telephone | 770-928-5130
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Fax |
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Provider Business Mailing Address
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Address Line | 2520 PEACHTREE RD NW UNIT #113
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City | ATLANTA
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State | GA
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Zip | 30305-3691
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Country | US
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Telephone | 770-928-5130
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAN MARTIN
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Credential | MS, LPC, NCC
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Telephone | 770-928-5130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC003929
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License Number State | GA
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