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General NPI Number Information
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NPI Number | 1619431400
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Entity Type | Organization
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Legal Business Name | WISDOM CENTER
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 2671 CENTERVILLE HWY STE 150
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City | SNELLVILLE
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State | GA
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Zip | 30078-4538
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Country | US
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Telephone | 404-913-2152
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Fax | 404-759-2699
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Provider Business Mailing Address
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Address Line | 50 KENTSHIRE PL
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7388
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Country | US
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Telephone | 404-913-2152
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Fax | 404-759-2699
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Authorized Official
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Title or Position | OWNER
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Name | BIANCA T STEPHENS
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Credential |
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Telephone | 404-913-2152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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