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General NPI Number Information
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NPI Number | 1427715747
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Entity Type | Organization
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Legal Business Name | SJBM ENTERPRISES LLC
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Dates
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Enumeration Date | 11/22/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 15 LAGRANGE ST STE C
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City | NEWNAN
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State | GA
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Zip | 30263-2693
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Country | US
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Telephone | 770-328-2731
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Fax |
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Provider Business Mailing Address
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Address Line | 147 HUNTERIAN PL
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City | NEWNAN
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State | GA
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Zip | 30265-5619
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Country | US
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Telephone | 770-328-2731
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Fax |
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Authorized Official
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Title or Position | OWNER/ PROVIDER
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Name | STEFANIE MOORE
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Credential | LPC
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Telephone | 770-328-0490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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