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General NPI Number Information
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NPI Number | 1356700041
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Entity Type | Organization
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Legal Business Name | MATERNAL INSYNC LLC
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 5149 MADISON GREEN DR SW
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City | MABLETON
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State | GA
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Zip | 30126-2151
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Country | US
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Telephone | 678-310-3012
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Fax |
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Provider Business Mailing Address
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Address Line | 5149 MADISON GREEN DR SW
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City | MABLETON
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State | GA
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Zip | 30126-2151
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Country | US
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Telephone | 678-310-3012
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Fax |
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Authorized Official
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Title or Position | OWNER, CLINICAL DIRECTOR
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Name | MRS. TIFFANY CONYERS
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Credential | LCSW
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Telephone | 803-414-4891
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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 | CSW005601
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | CSW005601
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License Number State | GA
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