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General NPI Number Information
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NPI Number | 1689244170
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Entity Type | Organization
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Legal Business Name | SELF-CARE MENTAL HEALTH & WELLNESS
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 600 WESTRIDGE PKWY STE 714
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City | MCDONOUGH
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State | GA
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Zip | 30253-7789
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Country | US
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Telephone | 718-715-6993
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Fax |
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Provider Business Mailing Address
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Address Line | 205 BENEFIELD CT
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-0965
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Country | US
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Telephone | 718-715-6993
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Fax |
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Authorized Official
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Title or Position | CEO/PMHNP
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Name | LYDIA SHEPPARD-THORNTON
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Credential | DNP, PMHNP-BC
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Telephone | 718-715-6993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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