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General NPI Number Information
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NPI Number | 1700675071
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Entity Type | Organization
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Legal Business Name | THE WINGS OF DRAGONFLY LLC.
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Dates
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Enumeration Date | 05/03/2025
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Last Update Date | 05/03/2025
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Provider Practice Location Address
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Address Line | 4390 EARNEY RD STE 110
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City | WOODSTOCK
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State | GA
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Zip | 30188-5687
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Country | US
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Telephone | 678-372-3099
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Fax |
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Provider Business Mailing Address
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Address Line | 5555 VAUGHN RD
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City | WOODSTOCK
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State | GA
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Zip | 30188-2007
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Country | US
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Telephone | 678-372-3099
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Fax |
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Authorized Official
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Title or Position | FOUNDER/ ADDICTION COUNSELOR
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Name | MRS. VICTORIA TESKA
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Credential | CADC2
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Telephone | 678-372-3099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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