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General NPI Number Information
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NPI Number | 1447169784
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Entity Type | Organization
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Legal Business Name | BUILT-EMPOWERED-EQUIPPED LLC
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Dates
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Enumeration Date | 09/03/2026
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 507 ROCK SHADOW CT
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-5644
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Country | US
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Telephone | 470-287-3699
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Fax |
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Provider Business Mailing Address
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Address Line | 8170 MALL PKWY # 1250
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City | LITHONIA
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State | GA
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Zip | 30038-2545
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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 | LICENSED PROFESSIONAL COUNSELOR
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Name | JASMINE GHOLSTON
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Credential | LPC
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Telephone | 470-287-3699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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