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General NPI Number Information
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NPI Number | 1679258610
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Entity Type | Organization
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Legal Business Name | GROW-N2B-BETTER THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 06/19/2023
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 4485 LAWRENCEVILLE HWY NW STE 207
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City | LILBURN
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State | GA
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Zip | 30047-3633
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Country | US
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Telephone | 470-403-3036
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 391132
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City | SNELLVILLE
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State | GA
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Zip | 30039-0019
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Country | US
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Telephone | 470-403-3036
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHANIQUE GRIFFITHS
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Credential | LPC
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Telephone | 470-403-3036
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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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