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General NPI Number Information
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NPI Number | 1578078523
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Entity Type | Organization
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Legal Business Name | OPENING UP, LLC
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 201 17TH ST NW STE 300
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City | ATLANTA
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State | GA
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Zip | 30363-1191
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Country | US
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Telephone | 770-628-7255
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Fax | 770-628-7256
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Provider Business Mailing Address
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Address Line | 1100 PEACHTREE ST NE STE 900
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City | ATLANTA
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State | GA
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Zip | 30309-4516
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Country | US
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Telephone | 678-334-2640
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Fax | 678-334-2641
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. GEORGE WILLIAMS
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Credential | LCSW
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Telephone | 678-334-2640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004849
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License Number State | GA
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