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General NPI Number Information
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NPI Number | 1699185173
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Entity Type | Organization
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Legal Business Name | SOCIAL BUTTERFLIES YOUTH SERVICES, INC.
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 124 S MAIN ST SUITE 2A
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City | JONESBORO
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State | GA
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Zip | 30236-3599
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Country | US
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Telephone | 404-491-0922
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Fax | 866-601-5225
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Provider Business Mailing Address
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Address Line | 124 S MAIN ST SUITE 2A
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City | JONESBORO
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State | GA
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Zip | 30236-3599
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Country | US
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Telephone | 404-491-0922
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Fax | 866-601-5225
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. LAKEACHA MICHELLE JETT
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Credential | ED.D.
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Telephone | 404-953-2590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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