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General NPI Number Information
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NPI Number | 1558071712
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Entity Type | Organization
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Legal Business Name | CULTIVATE JCF LLC
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 3525 PIEDMONT ROAD BUILDING 7, SUITE 408
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City | ATLANTA
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State | GA
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Zip | 30305
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Country | US
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Telephone | 404-624-6740
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Fax |
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Provider Business Mailing Address
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Address Line | 820 OVERHILL CT
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City | ATLANTA
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State | GA
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Zip | 30328-3659
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Country | US
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Telephone | 404-906-5620
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Fax |
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Authorized Official
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Title or Position | OWNER, DIRECTOR
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Name | MRS. MAZI ROBINSON
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Credential | LPC
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Telephone | 404-906-5620
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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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